Provider Demographics
NPI:1538860853
Name:BROCAR, SANDRA G
Entity type:Individual
Prefix:
First Name:SANDRA
Middle Name:G
Last Name:BROCAR
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 1:4129 N 16TH ST
Mailing Address - Street 2:
Mailing Address - City:ENID
Mailing Address - State:OK
Mailing Address - Zip Code:73701-6737
Mailing Address - Country:US
Mailing Address - Phone:580-324-9366
Mailing Address - Fax:
Practice Address - Street 1:1012 W CHERRY AVE
Practice Address - Street 2:
Practice Address - City:ENID
Practice Address - State:OK
Practice Address - Zip Code:73703-3317
Practice Address - Country:US
Practice Address - Phone:580-324-9366
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-03-14
Last Update Date:2023-03-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
No251G00000XAgenciesHospice Care, Community Based