Provider Demographics
NPI:1013532209
Name:FLUSCHE, BREANNE KALI
Entity type:Individual
Prefix:
First Name:BREANNE
Middle Name:KALI
Last Name:FLUSCHE
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 1:200 N BRYANT AVE STE 120
Mailing Address - Street 2:
Mailing Address - City:EDMOND
Mailing Address - State:OK
Mailing Address - Zip Code:73034-6273
Mailing Address - Country:US
Mailing Address - Phone:405-832-6881
Mailing Address - Fax:833-941-1685
Practice Address - Street 1:200 N BRYANT AVE STE 120
Practice Address - Street 2:
Practice Address - City:EDMOND
Practice Address - State:OK
Practice Address - Zip Code:73034-6273
Practice Address - Country:US
Practice Address - Phone:405-832-6881
Practice Address - Fax:405-578-9818
Is Sole Proprietor?:No
Enumeration Date:2020-06-12
Last Update Date:2024-09-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK106402363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily