Healthcare Provider Details

I. General information

NPI: 1144656331
Provider Name (Legal Business Name): SHAUN CARRICK BARANOWSKI APRN-CNM
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: SHAUN LESSER APRN-CNM

II. Dates (important events)

Enumeration Date: 09/19/2013
Last Update Date: 01/10/2022
Certification Date: 01/10/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

717 S HOUSTON AVE STE 200
TULSA OK
74127-9005
US

IV. Provider business mailing address

5310 E 31ST ST FL 13
TULSA OK
74135-5018
US

V. Phone/Fax

Practice location:
  • Phone: 918-586-4500
  • Fax: 918-586-4528
Mailing address:
  • Phone: 918-561-5701
  • Fax: 918-561-1173

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367A00000X
TaxonomyAdvanced Practice Midwife
License Number92717
License Number StateOK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: