Individual
MR. NICHOLAS PAUL BLACK
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
CRNA
Contact information
Practice address
1201 HEALTH CENTER PKWY, YUKON, OK 73099-6381
(405) 717-6800
(405) 717-7964
Mailing address
PO BOX 26901, OKLAHOMA CITY, OK 73126-0901
(405) 271-4351
(405) 271-8695
Taxonomy
Speciality
Code
Description
License number
State
367500000X
Certified Registered Nurse Anesthetist
Primary
94051
OK
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
200226570A
—
OK
Enumeration date
01/23/2009
Last updated
12/06/2021
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