Provider Demographics
NPI:1275567695
Name:BRANT, LYN GLEZEN (APRN)
Entity Type:Individual
Prefix:MS
First Name:LYN
Middle Name:GLEZEN
Last Name:BRANT
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6801 NW 39TH EXPRESSWAY
Mailing Address - Street 2:DEACONESS FAMILY CARE, BETHANY
Mailing Address - City:BETHANY
Mailing Address - State:OK
Mailing Address - Zip Code:70008-8650
Mailing Address - Country:US
Mailing Address - Phone:877-455-4778
Mailing Address - Fax:405-789-7978
Practice Address - Street 1:6801 NW 39TH EXPY
Practice Address - Street 2:
Practice Address - City:BETHANY
Practice Address - State:OK
Practice Address - Zip Code:73008-2501
Practice Address - Country:US
Practice Address - Phone:405-789-2441
Practice Address - Fax:405-789-7978
Is Sole Proprietor?:No
Enumeration Date:2006-07-10
Last Update Date:2012-04-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OKR0024436363L00000X, 363LA2200X, 363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
OKCH9820OtherMEDICARE RR GROUP #
OKS55621Medicare UPIN
OK$$$$$$$$$Medicare PIN