Healthcare Provider Details

I. General information

NPI: 1417393158
Provider Name (Legal Business Name): OWL ANESTHESIA APRN-CRNA, PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/21/2013
Last Update Date: 05/21/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2825 PARKLAWN DR MIDWEST REGIONAL MEDICAL CENTER
MIDWEST CITY OK
73110-4201
US

IV. Provider business mailing address

2502 ASHE CREEK DR
EDMOND OK
73034-5949
US

V. Phone/Fax

Practice location:
  • Phone: 405-360-7576
  • Fax: 405-360-7762
Mailing address:
  • Phone: 276-971-7319
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License Number104163
License Number StateOK

VIII. Authorized Official

Name: WILLIAM ROBBIN SAUNDERS
Title or Position: PRESIDENT
Credential: APRN-CRNA
Phone: 276-971-7319