Healthcare Provider Details

I. General information

NPI: 1033593207
Provider Name (Legal Business Name): QUANISHA ROBERSON DO
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/16/2015
Last Update Date: 04/08/2025
Certification Date: 04/08/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4502 E 41ST ST
TULSA OK
74135-2536
US

IV. Provider business mailing address

4502 E 41ST ST
TULSA OK
74135-2536
US

V. Phone/Fax

Practice location:
  • Phone: 918-619-4200
  • Fax:
Mailing address:
  • Phone: 918-619-4200
  • Fax: 918-619-4216

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code364S00000X
TaxonomyClinical Nurse Specialist
License Number98124
License Number StateOK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: