Provider Demographics
NPI:1194251603
Name:EMILY SUZANNE ESTLE APRN-CRNA PC
Entity type:Organization
Organization Name:EMILY SUZANNE ESTLE APRN-CRNA PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:EMILY
Authorized Official - Middle Name:SUZANNE
Authorized Official - Last Name:ESTLE
Authorized Official - Suffix:
Authorized Official - Credentials:APRN-CRNA
Authorized Official - Phone:405-308-1735
Mailing Address - Street 1:419 W GRAY ST
Mailing Address - Street 2:
Mailing Address - City:NORMAN
Mailing Address - State:OK
Mailing Address - Zip Code:73069-7117
Mailing Address - Country:US
Mailing Address - Phone:405-329-7300
Mailing Address - Fax:405-364-5379
Practice Address - Street 1:1240 SW 44TH ST
Practice Address - Street 2:
Practice Address - City:OKLAHOMA CITY
Practice Address - State:OK
Practice Address - Zip Code:73109-3604
Practice Address - Country:US
Practice Address - Phone:405-631-1527
Practice Address - Fax:405-631-9930
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-05-03
Last Update Date:2017-05-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OKR0073283367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified RegisteredGroup - Single Specialty