Healthcare Provider Details

I. General information

NPI: 1477573020
Provider Name (Legal Business Name): MICHAEL LANCE NORTON CRNA
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/19/2006
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

6600 S SYCAMORE AVE
BROKEN ARROW OK
74011-6028
US

V. Phone/Fax

Practice location:
  • Phone: 918-388-0462
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License NumberR0084439
License Number StateOK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: