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General NPI Number Information
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NPI Number | 1205831708
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Entity Type | Individual
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Provider Name | JENNIFER CAROL REXROAD C.R.N.A.
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Gender | Female
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Dates
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Enumeration Date | 06/20/2005
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Last Update Date | 08/08/2019
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Provider Practice Location Address
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Address Line | 6839 S CANTON AVE
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City | TULSA
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State | OK
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Zip | 74136-3402
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Country | US
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Telephone | 918-494-0612
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Fax | 918-481-5170
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Provider Business Mailing Address
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Address Line | 903 N OSAGE ST
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City | CHOUTEAU
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State | OK
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Zip | 74337-3777
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Country | US
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Telephone | 918-476-7779
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 367500000X
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Taxonomy Name | Certified Registered Nurse Anesthetist
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License Number | R0062121
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License Number State | OK
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