Provider Demographics
NPI:1912027251
Name:NOGHABAI, BRENDA KAY
Entity Type:Individual
Prefix:MS
First Name:BRENDA
Middle Name:KAY
Last Name:NOGHABAI
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:RT 1 BOX 103F
Mailing Address - Street 2:
Mailing Address - City:AGRA
Mailing Address - State:OK
Mailing Address - Zip Code:74824-9722
Mailing Address - Country:US
Mailing Address - Phone:918-375-2415
Mailing Address - Fax:
Practice Address - Street 1:406 NE 5TH
Practice Address - Street 2:
Practice Address - City:PERKINS
Practice Address - State:OK
Practice Address - Zip Code:74059-3009
Practice Address - Country:US
Practice Address - Phone:405-547-2130
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-03-30
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747P1801XNursing Service Related ProvidersTechnicianPersonal Care Attendant