Healthcare Provider Details

I. General information

NPI: 1972509727
Provider Name (Legal Business Name): WAYNE JOSEPH GARTNER CRNA
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/27/2005
Last Update Date: 05/19/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8801 S 101ST EAST AVE
TULSA OK
74133-5716
US

IV. Provider business mailing address

7912 E 31ST CT STE 210
TULSA OK
74145-1315
US

V. Phone/Fax

Practice location:
  • Phone: 918-294-4915
  • Fax:
Mailing address:
  • Phone: 918-392-4477
  • Fax: 918-392-4465

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License NumberR0062397
License Number StateOK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: