Healthcare Provider Details

I. General information

NPI: 1942504246
Provider Name (Legal Business Name): TERRY S ABERCROMBIE CRNA PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/29/2010
Last Update Date: 12/29/2010
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

2333 SW 97TH ST
OKLAHOMA CITY OK
73159-7403
US

V. Phone/Fax

Practice location:
  • Phone: 405-809-4200
  • Fax: 405-364-5379
Mailing address:
  • Phone: 405-535-2302
  • Fax: 405-364-5379

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License NumberR0090180
License Number StateOK

VIII. Authorized Official

Name: TERRY SCOTT ABERCROMCIE
Title or Position: PRESIDENT
Credential: CRNA
Phone: 405-535-2302