Provider Demographics
NPI:1083708580
Name:FOORE, NANETTE RACHEL (CRNA)
Entity Type:Individual
Prefix:
First Name:NANETTE
Middle Name:RACHEL
Last Name:FOORE
Suffix:
Gender:F
Credentials:CRNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4500 S. GARNETT RD
Mailing Address - Street 2:SUITE 919
Mailing Address - City:TULSA
Mailing Address - State:OK
Mailing Address - Zip Code:74146
Mailing Address - Country:US
Mailing Address - Phone:918-728-6194
Mailing Address - Fax:918-664-2521
Practice Address - Street 1:4500 S. GARNETT RD
Practice Address - Street 2:SUITE 919
Practice Address - City:TULSA
Practice Address - State:OK
Practice Address - Zip Code:74146
Practice Address - Country:US
Practice Address - Phone:918-728-6194
Practice Address - Fax:918-664-2521
Is Sole Proprietor?:No
Enumeration Date:2006-10-02
Last Update Date:2007-12-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OKR0044983367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
OKP00283019Medicare PIN