Healthcare Provider Details

I. General information

NPI: 1912724519
Provider Name (Legal Business Name): LANDON SHEAMAN CRNA
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/24/2024
Last Update Date: 09/24/2024
Certification Date: 09/24/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2621 N WHISENANT DR
DUNCAN OK
73533-0911
US

IV. Provider business mailing address

169900 LAKEVIEW DR
MARLOW OK
73055-4563
US

V. Phone/Fax

Practice location:
  • Phone: 580-252-5300
  • Fax:
Mailing address:
  • Phone: 580-221-1997
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License Number220437
License Number StateOK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: