Provider Demographics
NPI:1912580887
Name:BROCKWAY, JULIA LYNN I
Entity Type:Individual
Prefix:
First Name:JULIA
Middle Name:LYNN
Last Name:BROCKWAY
Suffix:I
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 1:40803 S COUNTY ROAD 213
Mailing Address - Street 2:
Mailing Address - City:MOORELAND
Mailing Address - State:OK
Mailing Address - Zip Code:73852-9131
Mailing Address - Country:US
Mailing Address - Phone:580-216-7182
Mailing Address - Fax:
Practice Address - Street 1:40803 S COUNTY ROAD 213
Practice Address - Street 2:
Practice Address - City:MOORELAND
Practice Address - State:OK
Practice Address - Zip Code:73852-9131
Practice Address - Country:US
Practice Address - Phone:580-216-7182
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-04-29
Last Update Date:2021-04-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes175T00000XOther Service ProvidersPeer Specialist