Healthcare Provider Details

I. General information

NPI: 1083643183
Provider Name (Legal Business Name): LINDA J MCILWEE CRNA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/01/2006
Last Update Date: 10/24/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

600 S MONROE ST
ENID OK
73701-7211
US

IV. Provider business mailing address

626 DEER RUN
ENID OK
73703-3426
US

V. Phone/Fax

Practice location:
  • Phone: 580-233-2300
  • Fax: 580-237-6174
Mailing address:
  • Phone: 580-242-3003
  • Fax: 580-237-6174

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License NumberR0024786
License Number StateOK
# 2
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License NumberR0024786
License Number StateOK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: