Healthcare Provider Details

I. General information

NPI: 1447939491
Provider Name (Legal Business Name): SHELBIE GWINN MAUK CRNA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/17/2023
Last Update Date: 08/14/2025
Certification Date: 08/14/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2825 PARKLAWN DR
OKLAHOMA CITY OK
73110-4201
US

IV. Provider business mailing address

2825 PARKLAWN DR
OKLAHOMA CITY OK
73110-4201
US

V. Phone/Fax

Practice location:
  • Phone: 405-610-4411
  • Fax:
Mailing address:
  • Phone: 405-610-4411
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number161477
License Number StateLA
# 2
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License Number215976
License Number StateOK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: