Individual
GRANT ROESLER
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
CRNA
Contact information
Practice address
1400 BRYAN DRIVE, DURANT, OK 74702
(580) 931-3312
Mailing address
PO BOX 1308, DURANT, OK 74702-1308
(936) 676-8655
Taxonomy
Speciality
Code
Description
License number
State
367500000X
Certified Registered Nurse Anesthetist
Primary
R0076619
OK
367500000X
Certified Registered Nurse Anesthetist
RNA193066
ME
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
200091550B
—
OK
Enumeration date
05/15/2006
Last updated
04/07/2021
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