Provider Demographics
NPI:1255678876
Name:PIERCE, MICHAEL TYLER (CRNA)
Entity Type:Individual
Prefix:
First Name:MICHAEL
Middle Name:TYLER
Last Name:PIERCE
Suffix:
Gender:M
Credentials:CRNA
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Mailing Address - Street 1:6839 S CANTON AVE
Mailing Address - Street 2:
Mailing Address - City:TULSA
Mailing Address - State:OK
Mailing Address - Zip Code:74136-3402
Mailing Address - Country:US
Mailing Address - Phone:918-494-0612
Mailing Address - Fax:918-481-5170
Practice Address - Street 1:1201 HEALTH CENTER PKWY
Practice Address - Street 2:
Practice Address - City:YUKON
Practice Address - State:OK
Practice Address - Zip Code:73099-6381
Practice Address - Country:US
Practice Address - Phone:405-717-6800
Practice Address - Fax:405-717-7964
Is Sole Proprietor?:No
Enumeration Date:2013-01-16
Last Update Date:2022-07-21
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
OK92637367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered