Individual
MR. PHILIP NONE STREETMAN
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
CRNA
Contact information
Practice address
500 POLK CREEK ST, POTEAU, OK 74953-5420
(918) 649-3426
(918) 649-3426
Mailing address
PO BOX 727, POTEAU, OK 74953-0727
(918) 649-3426
(918) 649-3426
Taxonomy
Speciality
Code
Description
License number
State
367500000X
Certified Registered Nurse Anesthetist
Primary
R0023472
OK
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
363399510002
BLUE CROSS BLUE SHEILD
OK
Enumeration date
08/15/2005
Last updated
11/12/2007
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