Provider Demographics
NPI:1306066584
Name:WEEKS, ELDON WAYNE (CRNA)
Entity type:Individual
Prefix:MR
First Name:ELDON
Middle Name:WAYNE
Last Name:WEEKS
Suffix:
Gender:M
Credentials:CRNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 720006
Mailing Address - Street 2:
Mailing Address - City:NORMAN
Mailing Address - State:OK
Mailing Address - Zip Code:73070-4006
Mailing Address - Country:US
Mailing Address - Phone:405-533-6057
Mailing Address - Fax:
Practice Address - Street 1:1212 4TH ST
Practice Address - Street 2:
Practice Address - City:PAWNEE
Practice Address - State:OK
Practice Address - Zip Code:74058-4046
Practice Address - Country:US
Practice Address - Phone:918-762-2577
Practice Address - Fax:918-762-6008
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-27
Last Update Date:2019-07-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OKR 0040640367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK10078792014Medicaid