Provider Demographics
NPI:1528539475
Name:ALLEN, ANGEL MARIE (APRN)
Entity Type:Individual
Prefix:
First Name:ANGEL
Middle Name:MARIE
Last Name:ALLEN
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:ANGEL
Other - Middle Name:MARIE
Other - Last Name:BRULAR
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1705 E 19TH ST STE 502
Mailing Address - Street 2:
Mailing Address - City:TULSA
Mailing Address - State:OK
Mailing Address - Zip Code:74104-5416
Mailing Address - Country:US
Mailing Address - Phone:918-748-7800
Mailing Address - Fax:918-403-6349
Practice Address - Street 1:1705 E 19TH ST STE 502
Practice Address - Street 2:
Practice Address - City:TULSA
Practice Address - State:OK
Practice Address - Zip Code:74104-5416
Practice Address - Country:US
Practice Address - Phone:918-748-7800
Practice Address - Fax:918-403-6349
Is Sole Proprietor?:No
Enumeration Date:2018-12-17
Last Update Date:2021-06-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK80252363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily