Provider Demographics
NPI:1770171787
Name:GARBER, NICOLE RACHELLE (APRN)
Entity type:Individual
Prefix:
First Name:NICOLE
Middle Name:RACHELLE
Last Name:GARBER
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2605 SW 119TH ST
Mailing Address - Street 2:STE B
Mailing Address - City:OKLAHOMA CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73170-2601
Mailing Address - Country:US
Mailing Address - Phone:405-996-8965
Mailing Address - Fax:
Practice Address - Street 1:700 S TELEPHONE RD STE 201
Practice Address - Street 2:
Practice Address - City:MOORE
Practice Address - State:OK
Practice Address - Zip Code:73160-2538
Practice Address - Country:US
Practice Address - Phone:405-912-3120
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-01-05
Last Update Date:2021-02-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK200606207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine