Basic Information
| Provider Information | |||||||||
| NPI: | 1770171787 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | GARBER | ||||||||
| FirstName: | NICOLE | ||||||||
| MiddleName: | RACHELLE | ||||||||
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| Credential: | APRN | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2605 SW 119TH ST | ||||||||
| Address2: | STE B | ||||||||
| City: | OKLAHOMA CITY | ||||||||
| State: | OK | ||||||||
| PostalCode: | 731702601 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4059968965 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 700 S TELEPHONE RD STE 201 | ||||||||
| Address2: | |||||||||
| City: | MOORE | ||||||||
| State: | OK | ||||||||
| PostalCode: | 731602538 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4059123120 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 01/05/2021 | ||||||||
| LastUpdateDate: | 02/25/2021 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 02/25/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207Q00000X | 200606 | OK | Y | Allopathic & Osteopathic Physicians | Family Medicine |
No ID Information.