Provider Demographics
NPI:1518413848
Name:BROOM, RASHAWNDA ESHELLE
Entity Type:Individual
Prefix:MS
First Name:RASHAWNDA
Middle Name:ESHELLE
Last Name:BROOM
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 1:9750 E. 31ST APT 404
Mailing Address - Street 2:
Mailing Address - City:TULSA
Mailing Address - State:OK
Mailing Address - Zip Code:74146
Mailing Address - Country:US
Mailing Address - Phone:918-886-5230
Mailing Address - Fax:
Practice Address - Street 1:1870 S. BOULDER
Practice Address - Street 2:
Practice Address - City:TULSA
Practice Address - State:OK
Practice Address - Zip Code:74119
Practice Address - Country:US
Practice Address - Phone:918-585-1213
Practice Address - Fax:918-585-1263
Is Sole Proprietor?:No
Enumeration Date:2016-08-28
Last Update Date:2016-08-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK172V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172V00000XOther Service ProvidersCommunity Health Worker