Basic Information
| Provider Information | |||||||||
| NPI: | 1518413848 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | BROOM | ||||||||
| FirstName: | RASHAWNDA | ||||||||
| MiddleName: | ESHELLE | ||||||||
| NamePrefix: | MS. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 9750 E. 31ST APT 404 | ||||||||
| Address2: | |||||||||
| City: | TULSA | ||||||||
| State: | OK | ||||||||
| PostalCode: | 74146 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9188865230 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 1870 S. BOULDER | ||||||||
| Address2: | |||||||||
| City: | TULSA | ||||||||
| State: | OK | ||||||||
| PostalCode: | 74119 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9185851213 | ||||||||
| FaxNumber: | 9185851263 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/28/2016 | ||||||||
| LastUpdateDate: | 08/28/2016 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 172V00000X | OK | Y | Other Service Providers | Community Health Worker |
No ID Information.