Organization
CHAZ WHITE ANESTHESIA SERVICES PC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. CHAZ WHITE C.R.N.A. (PRESIDENT)
(918) 995-7518
Entity
Organization
Contact information
Practice address
11912 S VINE ST, JENKS, OK 74037-4339
(918) 995-7518
Mailing address
11912 S VINE ST, JENKS, OK 74037-4339
(918) 995-7518
Taxonomy
Speciality
Code
Description
License number
State
367500000X
Certified Registered Nurse Anesthetist
Primary
R84680
OK
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
200307060A
—
OK
Enumeration date
05/09/2012
Last updated
08/08/2012
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