Provider Demographics
NPI:1063240166
Name:BARTRAM, TOBI NIKOLE
Entity type:Individual
Prefix:MRS
First Name:TOBI
Middle Name:NIKOLE
Last Name:BARTRAM
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13869 SE 211TH RD
Mailing Address - Street 2:
Mailing Address - City:TALIHINA
Mailing Address - State:OK
Mailing Address - Zip Code:74571-5875
Mailing Address - Country:US
Mailing Address - Phone:918-917-3330
Mailing Address - Fax:
Practice Address - Street 1:13869 SE 211TH RD
Practice Address - Street 2:
Practice Address - City:TALIHINA
Practice Address - State:OK
Practice Address - Zip Code:74571-5875
Practice Address - Country:US
Practice Address - Phone:918-917-3330
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-07-22
Last Update Date:2024-07-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator