Provider Demographics
NPI:1801170600
Name:BROWN, CHERYL L
Entity type:Individual
Prefix:
First Name:CHERYL
Middle Name:L
Last Name:BROWN
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 1:35010 S 4465 RD
Mailing Address - Street 2:
Mailing Address - City:VINITA
Mailing Address - State:OK
Mailing Address - Zip Code:74301-6672
Mailing Address - Country:US
Mailing Address - Phone:918-782-4050
Mailing Address - Fax:918-782-4766
Practice Address - Street 1:35010 S 4465 RD
Practice Address - Street 2:
Practice Address - City:VINITA
Practice Address - State:OK
Practice Address - Zip Code:74301-6672
Practice Address - Country:US
Practice Address - Phone:918-782-4050
Practice Address - Fax:918-782-4766
Is Sole Proprietor?:No
Enumeration Date:2011-09-28
Last Update Date:2011-09-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK261QM0801X171M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator