Healthcare Provider Details

I. General information

NPI: 1083708580
Provider Name (Legal Business Name): NANETTE RACHEL FOORE CRNA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/02/2006
Last Update Date: 12/04/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4500 S. GARNETT RD SUITE 919
TULSA OK
74146
US

IV. Provider business mailing address

4500 S. GARNETT RD SUITE 919
TULSA OK
74146
US

V. Phone/Fax

Practice location:
  • Phone: 918-728-6194
  • Fax: 918-664-2521
Mailing address:
  • Phone: 918-728-6194
  • Fax: 918-664-2521

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License NumberR0044983
License Number StateOK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: