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NPI Code Detail

MEDICARE: MR. WAYNE JOSEPH GARTNER CRNA

MEDICARE: MR. WAYNE JOSEPH GARTNER 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 AnesthetistR0062397OK

Medicare Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1900522349OTHEROKMEDICARE GROUP PIN

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
2MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1972509727
Entity Type Code : Individual
Provider Name (Legal Business Name) : MR. WAYNE JOSEPH GARTNER CRNA
Provider Business Mailing Address
First Line : 7912 E 31ST CT
Second Line : STE 210
City : TULSA
State : OK
Zip : 74145-1315
Country : US
Telephone Number : 918-392-4477
Fax Number : 918-392-4465
Provider Business Practice Location Address
First Line : 8801 S 101ST EAST AVE
Second Line :
City : TULSA
State : OK
Zip : 74133-5716
Country : US
Telephone Number : 918-294-4915
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 06/27/2005
Last Update Date : 05/19/2008

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