Individual
LISA M BENNETT
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
CRNA
Contact information
Practice address
4200 E SKELLY DR STE 100, TULSA, OK 74135-3235
(422) 191-8528
Mailing address
1578 E 59TH ST, TULSA, OK 74105-8006
(248) 505-2707
Taxonomy
Speciality
Code
Description
License number
State
367500000X
Certified Registered Nurse Anesthetist
4704205789
MI
367500000X
Certified Registered Nurse Anesthetist
Primary
R0134240
OK
367500000X
Certified Registered Nurse Anesthetist
RN-324508
OH
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
200879670A
—
OK
01
—
4704205789
MICHIGAN BOARD OF NURSING
MI
01
—
R0134240
OKLAHOMA BOARD OF NURSING
OK
Enumeration date
06/29/2006
Last updated
10/13/2022
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