Individual
TRACI RENEE WILMARTH
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
CRNA
Contact information
Practice address
9713 LAKECREST DR, OKLAHOMA CITY, OK 73159-6777
(405) 213-5351
Mailing address
9713 LAKECREST DR, OKLAHOMA CITY, OK 73159-6777
(405) 213-5351
Taxonomy
Speciality
Code
Description
License number
State
367500000X
Certified Registered Nurse Anesthetist
Primary
100545
OK
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1003245481
—
OK
Enumeration date
11/05/2013
Last updated
07/22/2015
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