Provider Demographics
NPI:1275831620
Name:WARE, JOSEPH L (CRNA)
Entity Type:Individual
Prefix:MR
First Name:JOSEPH
Middle Name:L
Last Name:WARE
Suffix:
Gender:M
Credentials:CRNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1303 E JACKSON AVE N
Mailing Address - Street 2:
Mailing Address - City:SAPULPA
Mailing Address - State:OK
Mailing Address - Zip Code:74066-3751
Mailing Address - Country:US
Mailing Address - Phone:918-527-6877
Mailing Address - Fax:
Practice Address - Street 1:1303 E JACKSON AVE N
Practice Address - Street 2:
Practice Address - City:SAPULPA
Practice Address - State:OK
Practice Address - Zip Code:74066-3751
Practice Address - Country:US
Practice Address - Phone:918-527-6877
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-03-09
Last Update Date:2011-03-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK85835367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered