Individual
IVAN KOZHULENKO
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
CRNA
Contact information
Practice address
920 STANTON L YOUNG BLVD STE WP1140, OKLAHOMA CITY, OK 73104-5036
(405) 271-4351
(405) 271-8695
Mailing address
PO BOX 26901, OKLAHOMA CITY, OK 73126-0901
(405) 271-4351
(405) 271-8695
Taxonomy
Speciality
Code
Description
License number
State
367500000X
Certified Registered Nurse Anesthetist
Primary
127368
OK
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
12345
NONE
OK
Enumeration date
09/18/2018
Last updated
12/17/2020
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