Healthcare Provider Details

I. General information

NPI: 1700167699
Provider Name (Legal Business Name): HOLBROOK ANESTHESIA SERVICES INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/06/2011
Last Update Date: 09/06/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

419 W GRAY ST
NORMAN OK
73069-7117
US

IV. Provider business mailing address

412 FOREMAN AVE
NORMAN OK
73069-6610
US

V. Phone/Fax

Practice location:
  • Phone: 405-809-4200
  • Fax: 405-364-5379
Mailing address:
  • Phone: 405-307-0548
  • Fax: 405-307-9831

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License Number0024073
License Number StateOK

VIII. Authorized Official

Name: MONA L HOLBROOK
Title or Position: PRESIDENT
Credential: CRNA
Phone: 405-307-0548