Healthcare Provider Details

I. General information

NPI: 1871037614
Provider Name (Legal Business Name): KATIE ELIZABETH SHEARS CRNA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/13/2016
Last Update Date: 01/24/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1923 S UTICA AVE
TULSA OK
74104-6520
US

IV. Provider business mailing address

9734 S DELAWARE CT #1710
TULSA OK
74137-7431
US

V. Phone/Fax

Practice location:
  • Phone: 918-744-2345
  • Fax:
Mailing address:
  • Phone: 870-904-7381
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License Number106450
License Number StateOK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: