| Sunnylane Medical Clinic Llc | |
|
3916 S Sunnylane Rd Del City OK 73115-3656 | |
| (405) 455-5330 | |
| Not Available |
| Full Name | Sunnylane Medical Clinic Llc |
|---|---|
| Speciality | Family Medicine |
| Location | 3916 S Sunnylane Rd, Del City, Oklahoma |
| Authorized Official Name and Position | Braden Peterson (OWNER) |
| Authorized Official Contact | 4054555330 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Sunnylane Medical Clinic Llc 3916 S Sunnylane Rd Del City OK 73115-3656 Ph: (405) 455-5330 | Sunnylane Medical Clinic Llc 3916 S Sunnylane Rd Del City OK 73115-3656 Ph: (405) 455-5330 |
| NPI Number | 1255922811 |
|---|---|
| Provider Enumeration Date | 01/27/2021 |
| Last Update Date | 08/14/2023 |
| Medicare PECOS PAC ID | 0042608820 |
|---|---|
| Medicare Enrollment ID | O20211027002677 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1255922811 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207Q00000X | Family Medicine | (* (Not Available)) | Primary |
| 261QU0200X | Clinic/center - Urgent Care | (* (Not Available)) | Secondary |
| Provider Name | Denise Joan Martin |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1548568512 PECOS PAC ID: 8022144997 Enrollment ID: I20170127002097 |
| Provider Name | Braden Peterson |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1245762020 PECOS PAC ID: 0941587430 Enrollment ID: I20170510002622 |
| Provider Name | Mendy Marie Stoeser |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1629540893 PECOS PAC ID: 3173956976 Enrollment ID: I20191210000541 |
| Provider Name | Billie J Scott |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1083174700 PECOS PAC ID: 2365878543 Enrollment ID: I20211007001034 |
| Provider Name | Jana M Webb |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1568044501 PECOS PAC ID: 1850780933 Enrollment ID: I20211110002846 |
| Provider Name | Kandice Danielle Haines |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1306504964 PECOS PAC ID: 3375934037 Enrollment ID: I20220106002875 |
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