Provider Demographics
NPI:1366697401
Name:LINDER, BROOK MICHELLE (APRN-CNP)
Entity type:Individual
Prefix:
First Name:BROOK
Middle Name:MICHELLE
Last Name:LINDER
Suffix:
Gender:F
Credentials:APRN-CNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2804 PRAIRIE VIEW DR
Mailing Address - Street 2:
Mailing Address - City:PONCA CITY
Mailing Address - State:OK
Mailing Address - Zip Code:74604-3244
Mailing Address - Country:US
Mailing Address - Phone:580-761-1577
Mailing Address - Fax:
Practice Address - Street 1:2804 PRAIRIE VIEW DR
Practice Address - Street 2:
Practice Address - City:PONCA CITY
Practice Address - State:OK
Practice Address - Zip Code:74604-3244
Practice Address - Country:US
Practice Address - Phone:580-761-1577
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-11-17
Last Update Date:2023-05-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK212812363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily