Provider Demographics
NPI:1801114186
Name:MCBROOM, LINDA SUE (BA)
Entity type:Individual
Prefix:
First Name:LINDA
Middle Name:SUE
Last Name:MCBROOM
Suffix:
Gender:F
Credentials:BA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:RR 5 BOX 5230
Mailing Address - Street 2:
Mailing Address - City:STILWELL
Mailing Address - State:OK
Mailing Address - Zip Code:74960-9036
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:27753 S WELLING RD
Practice Address - Street 2:
Practice Address - City:WELLING
Practice Address - State:OK
Practice Address - Zip Code:74471-2202
Practice Address - Country:US
Practice Address - Phone:918-457-4999
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-05-11
Last Update Date:2010-05-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator