Provider Demographics
NPI:1932683687
Name:TREAGESSER, BRANDY RENE
Entity Type:Individual
Prefix:
First Name:BRANDY
Middle Name:RENE
Last Name:TREAGESSER
Suffix:
Gender:F
Credentials:
Other - Prefix:MRS
Other - First Name:BRANDY
Other - Middle Name:RENE
Other - Last Name:TREAGESSER
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:BSN RN
Mailing Address - Street 1:1313 E 20TH ST
Mailing Address - Street 2:
Mailing Address - City:OKMULGEE
Mailing Address - State:OK
Mailing Address - Zip Code:74447-6303
Mailing Address - Country:US
Mailing Address - Phone:918-591-5783
Mailing Address - Fax:918-591-5791
Practice Address - Street 1:1313 E 20TH ST
Practice Address - Street 2:
Practice Address - City:OKMULGEE
Practice Address - State:OK
Practice Address - Zip Code:74447-6303
Practice Address - Country:US
Practice Address - Phone:918-591-5783
Practice Address - Fax:918-591-5791
Is Sole Proprietor?:No
Enumeration Date:2018-09-19
Last Update Date:2018-09-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK112563163WP1700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WP1700XNursing Service ProvidersRegistered NursePerinatal