Healthcare Provider Details

I. General information

NPI: 1861540858
Provider Name (Legal Business Name): MARK ALAN SCHROEDER CRNA
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/08/2007
Last Update Date: 01/30/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6901 S OLYMPIA AVE
TULSA OK
74132-1843
US

IV. Provider business mailing address

4500 S GARNETT RD STE 300
TULSA OK
74146-5238
US

V. Phone/Fax

Practice location:
  • Phone: 918-388-5701
  • Fax:
Mailing address:
  • Phone: 918-392-2944
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License Number61134
License Number StateOK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: