Provider Demographics
NPI:1275311219
Name:RETTMAN, BRANDI SUE
Entity Type:Individual
Prefix:
First Name:BRANDI
Middle Name:SUE
Last Name:RETTMAN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:BRANDI
Other - Middle Name:SUE
Other - Last Name:WHITE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1812 COUNCIL BLUFF DR
Mailing Address - Street 2:
Mailing Address - City:EDMOND
Mailing Address - State:OK
Mailing Address - Zip Code:73013-6867
Mailing Address - Country:US
Mailing Address - Phone:405-205-7527
Mailing Address - Fax:
Practice Address - Street 1:1812 COUNCIL BLUFF DR
Practice Address - Street 2:
Practice Address - City:EDMOND
Practice Address - State:OK
Practice Address - Zip Code:73013-6867
Practice Address - Country:US
Practice Address - Phone:405-205-7527
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-09-20
Last Update Date:2023-09-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK171M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator