Provider Demographics
NPI:1316917420
Name:ARREDONDO, ALBERT JR (MSN, CRNA)
Entity type:Individual
Prefix:
First Name:ALBERT
Middle Name:
Last Name:ARREDONDO
Suffix:JR
Gender:M
Credentials:MSN, CRNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7801 NW BRADY WAY
Mailing Address - Street 2:
Mailing Address - City:LAWTON
Mailing Address - State:OK
Mailing Address - Zip Code:73505-0600
Mailing Address - Country:US
Mailing Address - Phone:210-386-8008
Mailing Address - Fax:
Practice Address - Street 1:4301 MOW-WAY RD
Practice Address - Street 2:RACH (ATTN:MCUA-QC, MS. PRESCOTT)
Practice Address - City:FORT SILL
Practice Address - State:OK
Practice Address - Zip Code:73505-6300
Practice Address - Country:US
Practice Address - Phone:580-458-2134
Practice Address - Fax:580-458-2314
Is Sole Proprietor?:No
Enumeration Date:2006-01-23
Last Update Date:2017-12-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK0087300367500000X, 163W00000X
TX648163163W00000X, 367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
No163W00000XNursing Service ProvidersRegistered Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK200114700AMedicaid