Provider Demographics
NPI:1255740288
Name:BRICKLEY, MIRANDA
Entity type:Individual
Prefix:MS
First Name:MIRANDA
Middle Name:
Last Name:BRICKLEY
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 1:1824 NW 39TH ST
Mailing Address - Street 2:APT 210
Mailing Address - City:OKLAHOMA CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73118-2678
Mailing Address - Country:US
Mailing Address - Phone:580-318-1496
Mailing Address - Fax:
Practice Address - Street 1:1824 NW 39TH ST
Practice Address - Street 2:APT 210
Practice Address - City:OKLAHOMA CITY
Practice Address - State:OK
Practice Address - Zip Code:73118-2678
Practice Address - Country:US
Practice Address - Phone:580-318-1496
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-08-04
Last Update Date:2014-08-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program