Provider Demographics
NPI:1275248197
Name:BROPLEH, CLANCY OMOKHODION
Entity Type:Individual
Prefix:
First Name:CLANCY
Middle Name:OMOKHODION
Last Name:BROPLEH
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7127 PANTHER RIDGE DR
Mailing Address - Street 2:
Mailing Address - City:SPRING
Mailing Address - State:TX
Mailing Address - Zip Code:77389-1661
Mailing Address - Country:US
Mailing Address - Phone:401-835-4295
Mailing Address - Fax:
Practice Address - Street 1:7127 PANTHER RIDGE DR
Practice Address - Street 2:
Practice Address - City:SPRING
Practice Address - State:TX
Practice Address - Zip Code:77389-1661
Practice Address - Country:US
Practice Address - Phone:401-835-4295
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-01-16
Last Update Date:2023-01-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL9587499163WA2000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WA2000XNursing Service ProvidersRegistered NurseAdministrator