Individual
SCOTT C WIXOM
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
CRNA
Contact information
Practice address
1120 S UTICA AVE, TULSA, OK 74104-4012
(918) 728-4719
Mailing address
12518 S CEDAR AVE, JENKS, OK 74037-4983
(918) 728-7419
Taxonomy
Speciality
Code
Description
License number
State
367500000X
Certified Registered Nurse Anesthetist
Primary
2003026225
MO
Other
Enumeration date
05/17/2006
Last updated
07/08/2007
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