Healthcare Provider Details

I. General information

NPI: 1528050291
Provider Name (Legal Business Name): CAROL LYNN RHOADS CRNA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/18/2005
Last Update Date: 01/06/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1921 STONECIPHER DR CHICKASAW NATION HEALTH SYSTEM
ADA OK
74820-3439
US

IV. Provider business mailing address

1921 STONECIPHER DR CHICKASAW NATION HEALTH SYSTEM
ADA OK
74820-3439
US

V. Phone/Fax

Practice location:
  • Phone: 580-421-6248
  • Fax:
Mailing address:
  • Phone: 580-421-6248
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License NumberR0080710
License Number StateOK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: