MEDICARE: AMBER LADAWN SURZ

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	363L00000X	Nurse Practitioner	134215	OK

General Provider Information

NPI Number	:	1619524683
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	AMBER LADAWN SURZ

Provider Business Mailing Address
First Line	:	15949 SKY RUN DR
Second Line	:
City	:	EDMOND
State	:	OK
Zip	:	73013-8427
Country	:	US
Telephone Number	:	361-816-6916
Fax Number	:

Provider Business Practice Location Address
First Line	:	7017 N ROBINSON AVE
Second Line	:
City	:	OKLAHOMA CITY
State	:	OK
Zip	:	73116-9044
Country	:	US
Telephone Number	:	405-658-3130
Fax Number	:

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

Provider Enumeration Date	:	08/23/2019
Last Update Date	:	08/23/2019

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Directions to “ AMBER LADAWN SURZ ” Practice Location

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