Individual
MR. DOMINICK P PALMISANO
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
CRNA
Contact information
Practice address
1202 N MUSKOGEE PL, CLAREMORE, OK 74017-3058
(918) 392-4456
(918) 392-4465
Mailing address
7912 E 31ST CT, TULSA, OK 74145-1315
(918) 392-4456
(918) 392-4465
Taxonomy
Speciality
Code
Description
License number
State
367500000X
Certified Registered Nurse Anesthetist
Primary
R0049310
AR
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
100783690A
—
OK
01
—
1285810051
MEDICARE GROUP PIN
OK
Enumeration date
02/16/2006
Last updated
05/16/2008
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