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General NPI Number Information
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NPI Number | 1275089393
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Entity Type | Individual
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Provider Name | CHRISTINA JO-DENEE RIVERA CRNA
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Gender | Female
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Dates
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Enumeration Date | 08/29/2016
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Last Update Date | 08/29/2016
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Provider Practice Location Address
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Address Line | 1924 S UTICA AVE DAVIS TOWER, SUITE 600
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City | TULSA
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State | OK
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Zip | 74104-6510
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Country | US
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Telephone | 918-978-7239
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Fax |
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Provider Business Mailing Address
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Address Line | 717 W 51ST ST S
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City | WICHITA
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State | KS
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Zip | 67217-5305
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Country | US
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Telephone | 918-978-7239
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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 | 103840
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License Number State | OK
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