MEDICARE: CAROL LYNN RHOADS CRNA

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	367500000X	Certified Registered Nurse Anesthetist	R0080710	OK

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1528050291
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CAROL LYNN RHOADS CRNA

Provider Business Mailing Address
First Line	:	1921 STONECIPHER DR
Second Line	:	CHICKASAW NATION HEALTH SYSTEM
City	:	ADA
State	:	OK
Zip	:	74820-3439
Country	:	US
Telephone Number	:	580-421-6248
Fax Number	:

Provider Business Practice Location Address
First Line	:	1921 STONECIPHER DR
Second Line	:	CHICKASAW NATION HEALTH SYSTEM
City	:	ADA
State	:	OK
Zip	:	74820-3439
Country	:	US
Telephone Number	:	580-421-6248
Fax Number	:

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

Provider Enumeration Date	:	08/18/2005
Last Update Date	:	01/06/2015

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