Healthcare Provider Details

I. General information

NPI: 1669880761
Provider Name (Legal Business Name): ERICA BUEL CRNA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/01/2014
Last Update Date: 01/14/2022
Certification Date: 01/14/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9800 BROADWAY EXT
OKLAHOMA CITY OK
73114-6303
US

IV. Provider business mailing address

2710 S LOBLOLLY LN
EDMOND OK
73012-1301
US

V. Phone/Fax

Practice location:
  • Phone: 405-419-2980
  • Fax:
Mailing address:
  • Phone: 972-415-2282
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License Number110749
License Number StateOK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: