Provider Demographics
NPI:1831503291
Name:MCCLENNAN-BREWER, SHARISA NICOLE (LPN)
Entity type:Individual
Prefix:MRS
First Name:SHARISA
Middle Name:NICOLE
Last Name:MCCLENNAN-BREWER
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:327 S 119TH EAST AVE
Mailing Address - Street 2:
Mailing Address - City:TULSA
Mailing Address - State:OK
Mailing Address - Zip Code:74128-2232
Mailing Address - Country:US
Mailing Address - Phone:918-344-7826
Mailing Address - Fax:918-245-5564
Practice Address - Street 1:7010 S YALE AVE
Practice Address - Street 2:SUITE 215
Practice Address - City:TULSA
Practice Address - State:OK
Practice Address - Zip Code:74136-5713
Practice Address - Country:US
Practice Address - Phone:918-492-2554
Practice Address - Fax:918-492-8638
Is Sole Proprietor?:No
Enumeration Date:2014-06-13
Last Update Date:2014-06-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OKL0050964164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse