Healthcare Provider Details

I. General information

NPI: 1699969873
Provider Name (Legal Business Name): ELISHA RANNELL DOLBOW C.F.A.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/30/2007
Last Update Date: 09/06/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8803 S 101ST EAST AVE
TULSA OK
74133-5726
US

IV. Provider business mailing address

8803 S 101ST EAST AVE STE 383
TULSA OK
74133-5732
US

V. Phone/Fax

Practice location:
  • Phone: 918-392-5696
  • Fax: 918-392-5697
Mailing address:
  • Phone: 918-392-5696
  • Fax: 918-392-5697

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code246ZS0410X
TaxonomySurgical Technologist
License Number88620
License Number StateOK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: