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NPI Code Detail

MEDICARE: MRS. STEPHANIE MARIA ROBERSON CRNA

MEDICARE: MRS. STEPHANIE MARIA ROBERSON 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
1367500000XCertified Registered Nurse Anesthetist91130OK

General Provider Information

NPI Number : 1780006817
Entity Type Code : Individual
Provider Name (Legal Business Name) : MRS. STEPHANIE MARIA ROBERSON CRNA
Provider Business Mailing Address
First Line : 2707 NW 68TH ST
Second Line :
City : OKLAHOMA CITY
State : OK
Zip : 73116-4711
Country : US
Telephone Number : 918-840-3418
Fax Number :
Provider Business Practice Location Address
First Line : 750 NE 13TH ST STE 200
Second Line :
City : OKLAHOMA CITY
State : OK
Zip : 73104-5024
Country : US
Telephone Number : 405-271-4351
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 01/08/2014
Last Update Date : 01/08/2014

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