Organization
MOONLIGHT ANESTHESIA CONSULTING INC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
TRACI WILMARTH CRNA (CRNA)
(405) 213-5351
Entity
Organization
Contact information
Practice address
3705 NW 63RD ST, OKLAHOMA CITY, OK 73116-1935
(405) 213-5351
Mailing address
2115 BELLAIRE DR, MOORE, OK 73160-4206
(405) 213-5351
Taxonomy
Speciality
Code
Description
License number
State
207L00000X
Anesthesiology Physician
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1003245481
—
OK
Enumeration date
04/26/2022
Last updated
04/26/2022
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