| NPI | 1760945141 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | RACHEL RENEE WALLACE Director 918-284-2163 |
| Organization Subpart ? | No |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered |
| Enumeration Date | 2019-04-11 |
| Last Update Date | 2022-08-23 |