Provider Demographics
NPI:1538946751
Name:STANLEY, BRENNA NICOLE
Entity type:Individual
Prefix:
First Name:BRENNA
Middle Name:NICOLE
Last Name:STANLEY
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 1:5915 W MEMORIAL RD STE 110
Mailing Address - Street 2:
Mailing Address - City:OKLAHOMA CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73142-2022
Mailing Address - Country:US
Mailing Address - Phone:405-773-6665
Mailing Address - Fax:405-773-6671
Practice Address - Street 1:5915 W MEMORIAL RD STE 110
Practice Address - Street 2:
Practice Address - City:OKLAHOMA CITY
Practice Address - State:OK
Practice Address - Zip Code:73142-2022
Practice Address - Country:US
Practice Address - Phone:405-773-6665
Practice Address - Fax:405-773-6671
Is Sole Proprietor?:No
Enumeration Date:2023-09-11
Last Update Date:2024-02-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK215160207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine