Provider Demographics
NPI:1376028811
Name:BRANDWEIN, HEATHER FAWN (APRN CNP)
Entity Type:Individual
Prefix:
First Name:HEATHER
Middle Name:FAWN
Last Name:BRANDWEIN
Suffix:
Gender:F
Credentials:APRN CNP
Other - Prefix:
Other - First Name:HEATHER
Other - Middle Name:FAWN
Other - Last Name:ARRINGTON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1109 E 15TH ST
Mailing Address - Street 2:
Mailing Address - City:PAWHUSKA
Mailing Address - State:OK
Mailing Address - Zip Code:74056-1901
Mailing Address - Country:US
Mailing Address - Phone:918-287-5151
Mailing Address - Fax:
Practice Address - Street 1:1109 E 15TH ST
Practice Address - Street 2:
Practice Address - City:PAWHUSKA
Practice Address - State:OK
Practice Address - Zip Code:74056-1901
Practice Address - Country:US
Practice Address - Phone:918-287-5151
Practice Address - Fax:918-287-5152
Is Sole Proprietor?:No
Enumeration Date:2018-10-01
Last Update Date:2022-07-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK101558363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK101558OtherOKLAHOMA BOARD OF NURSING, APRN LICENSE