Healthcare Provider Details

I. General information

NPI: 1841979945
Provider Name (Legal Business Name): LUCIEN K NGOCHI APRN
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/14/2023
Last Update Date: 10/24/2023
Certification Date: 10/24/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1120 S UTICA AVE
TULSA OK
74104-4012
US

IV. Provider business mailing address

7747 S MEMORIAL DR APT 6308
TULSA OK
74133-3634
US

V. Phone/Fax

Practice location:
  • Phone: 918-579-1000
  • Fax:
Mailing address:
  • Phone: 281-569-9954
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License Number215079
License Number StateOK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: