Provider Demographics
NPI:1417920471
Name:CANTRELL, NORMAN DALE (CRNA)
Entity type:Individual
Prefix:MR
First Name:NORMAN
Middle Name:DALE
Last Name:CANTRELL
Suffix:
Gender:M
Credentials:CRNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:4500 S GARNETT RD
Mailing Address - Street 2:STE 300
Mailing Address - City:TULSA
Mailing Address - State:OK
Mailing Address - Zip Code:74146-5229
Mailing Address - Country:US
Mailing Address - Phone:918-664-9892
Mailing Address - Fax:918-392-2945
Practice Address - Street 1:10502 N 110TH EAST AVE
Practice Address - Street 2:
Practice Address - City:OWASSO
Practice Address - State:OK
Practice Address - Zip Code:74055-6655
Practice Address - Country:US
Practice Address - Phone:918-664-9892
Practice Address - Fax:918-392-2945
Is Sole Proprietor?:No
Enumeration Date:2006-02-09
Last Update Date:2009-04-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OKR0025796367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK100788440AMedicaid
OKOK402298Medicare PIN