Healthcare Provider Details

I. General information

NPI: 1407907694
Provider Name (Legal Business Name): TRISHA C ESHELMAN CRNA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: TRISHA C FERREN RN

II. Dates (important events)

Enumeration Date: 01/15/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6839 S CANTON AVE
TULSA OK
74136-3402
US

IV. Provider business mailing address

6839 S CANTON AVE
TULSA OK
74136-3402
US

V. Phone/Fax

Practice location:
  • Phone: 918-609-5335
  • Fax:
Mailing address:
  • Phone: 918-609-5335
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License Number0087450
License Number StateOK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: