Healthcare Provider Details

I. General information

NPI: 1497433510
Provider Name (Legal Business Name): BEATRICE OYINLOLA OLORUNNAIYE
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/10/2023
Last Update Date: 10/17/2023
Certification Date: 10/17/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9141 E 101ST PL
TULSA OK
74133-6920
US

IV. Provider business mailing address

9141 E 101ST PL
TULSA OK
74133-6920
US

V. Phone/Fax

Practice location:
  • Phone: 918-851-0887
  • Fax:
Mailing address:
  • Phone: 918-851-0887
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License Number215285
License Number StateOK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: