Provider Demographics
NPI:1013693878
Name:WISBY, BRIANNA LEIALOHA
Entity Type:Individual
Prefix:MISS
First Name:BRIANNA
Middle Name:LEIALOHA
Last Name:WISBY
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 1:19320 E ADMIRAL PL STE B
Mailing Address - Street 2:
Mailing Address - City:CATOOSA
Mailing Address - State:OK
Mailing Address - Zip Code:74015-3240
Mailing Address - Country:US
Mailing Address - Phone:918-340-2080
Mailing Address - Fax:918-342-0075
Practice Address - Street 1:19320 E ADMIRAL PL STE B
Practice Address - Street 2:
Practice Address - City:CATOOSA
Practice Address - State:OK
Practice Address - Zip Code:74015-3240
Practice Address - Country:US
Practice Address - Phone:918-340-2080
Practice Address - Fax:918-342-0075
Is Sole Proprietor?:Yes
Enumeration Date:2023-06-26
Last Update Date:2023-08-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator