Provider Demographics
NPI:1861773012
Name:BRUSHY ELEMENTARY SCHOOL
Entity type:Organization
Organization Name:BRUSHY ELEMENTARY SCHOOL
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SCHOOL NURSE/MEDICAID COORDINATOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:SHANNON
Authorized Official - Middle Name:RENE
Authorized Official - Last Name:EDWARDS
Authorized Official - Suffix:
Authorized Official - Credentials:RN, BSN
Authorized Official - Phone:918-775-4458
Mailing Address - Street 1:100968 S 4650 RD
Mailing Address - Street 2:
Mailing Address - City:SALLISAW
Mailing Address - State:OK
Mailing Address - Zip Code:74955-2672
Mailing Address - Country:US
Mailing Address - Phone:918-775-4458
Mailing Address - Fax:918-775-3638
Practice Address - Street 1:100968 S 4650 RD
Practice Address - Street 2:
Practice Address - City:SALLISAW
Practice Address - State:OK
Practice Address - Zip Code:74955-2672
Practice Address - Country:US
Practice Address - Phone:918-775-4458
Practice Address - Fax:918-775-3638
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-09-01
Last Update Date:2011-09-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251K00000XAgenciesPublic Health or Welfare