Healthcare Provider Details

I. General information

NPI: 1184855389
Provider Name (Legal Business Name): CAROLINE POWELL COUSSENS RN,ACNS-BC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/05/2009
Last Update Date: 06/28/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

200 W 46TH ST N DREAM CENTER
TULSA OK
74126-6675
US

IV. Provider business mailing address

200 W 46TH ST N
TULSA OK
74126-6675
US

V. Phone/Fax

Practice location:
  • Phone: 918-430-9984
  • Fax: 918-430-1013
Mailing address:
  • Phone: 918-430-9984
  • Fax: 918-430-1013

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code364SA2200X
TaxonomyAdult Health Clinical Nurse Specialist
License NumberR0042972
License Number StateOK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: