Healthcare Provider Details

I. General information

NPI: 1588927115
Provider Name (Legal Business Name): CHRISTOPHER JERROLD HANLE APRN-CRNA
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/19/2012
Last Update Date: 06/19/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1923 S UTICA AVE ANESTHESIA DEPT.
TULSA OK
74104-6520
US

IV. Provider business mailing address

1923 S UTICA AVE ANESTHESIA DEPT.
TULSA OK
74104-6520
US

V. Phone/Fax

Practice location:
  • Phone: 918-744-2345
  • Fax:
Mailing address:
  • Phone: 918-744-2345
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License Number4622
License Number StateOK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: