Provider Demographics
NPI:1962596544
Name:ESPOSITO-WORTHINGTON, WENDI (CRNA)
Entity type:Individual
Prefix:
First Name:WENDI
Middle Name:
Last Name:ESPOSITO-WORTHINGTON
Suffix:
Gender:F
Credentials:CRNA
Other - Prefix:
Other - First Name:WENDI
Other - Middle Name:
Other - Last Name:ESPOSITO
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:CRNA
Mailing Address - Street 1:30226 S HICKORY LN
Mailing Address - Street 2:
Mailing Address - City:COOKSON
Mailing Address - State:OK
Mailing Address - Zip Code:74427-2255
Mailing Address - Country:US
Mailing Address - Phone:620-249-3930
Mailing Address - Fax:918-453-2341
Practice Address - Street 1:30226 S HICKORY LN
Practice Address - Street 2:
Practice Address - City:COOKSON
Practice Address - State:OK
Practice Address - Zip Code:74427-2255
Practice Address - Country:US
Practice Address - Phone:620-249-3930
Practice Address - Fax:918-453-2341
Is Sole Proprietor?:No
Enumeration Date:2006-10-03
Last Update Date:2014-07-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS54559367500000X
OK94071367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS100314490AMedicaid
OK200406420AMedicaid
OK200406420AMedicaid
S50739Medicare UPIN
KS057212Medicare ID - Type Unspecified