Provider Demographics
NPI:1922417674
Name:DAVIS, BRENDA (CDE)
Entity Type:Individual
Prefix:MRS
First Name:BRENDA
Middle Name:
Last Name:DAVIS
Suffix:
Gender:F
Credentials:CDE
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2011 SADDLEBACK BLVD
Mailing Address - Street 2:
Mailing Address - City:NORMAN
Mailing Address - State:OK
Mailing Address - Zip Code:73072-2806
Mailing Address - Country:US
Mailing Address - Phone:405-593-6571
Mailing Address - Fax:405-964-2170
Practice Address - Street 1:105365 SOUTH HWY 102
Practice Address - Street 2:
Practice Address - City:MCLOUD
Practice Address - State:OK
Practice Address - Zip Code:74851
Practice Address - Country:US
Practice Address - Phone:405-964-2081
Practice Address - Fax:405-964-2170
Is Sole Proprietor?:Yes
Enumeration Date:2014-08-07
Last Update Date:2014-08-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK68458163WD0400X
OK21310468163WD0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WD0400XNursing Service ProvidersRegistered NurseDiabetes Educator