MEDICARE: CAROLINE POWELL COUSSENS RN,ACNS-BC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	364SA2200X	Adult Health Clinical Nurse Specialist	R0042972	OK

General Provider Information

NPI Number	:	1184855389
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CAROLINE POWELL COUSSENS RN,ACNS-BC

Provider Business Mailing Address
First Line	:	200 W 46TH ST N
Second Line	:
City	:	TULSA
State	:	OK
Zip	:	74126-6675
Country	:	US
Telephone Number	:	918-430-9984
Fax Number	:	918-430-1013

Provider Business Practice Location Address
First Line	:	200 W 46TH ST N
Second Line	:	DREAM CENTER
City	:	TULSA
State	:	OK
Zip	:	74126-6675
Country	:	US
Telephone Number	:	918-430-9984
Fax Number	:	918-430-1013

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/05/2009
Last Update Date	:	06/28/2010

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