Provider Demographics
NPI:1497840755
Name:HURST, SANDRA LEE (CRNA)
Entity Type:Individual
Prefix:
First Name:SANDRA
Middle Name:LEE
Last Name:HURST
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:PO BOX 98
Mailing Address - Street 2:
Mailing Address - City:OKMULGEE
Mailing Address - State:OK
Mailing Address - Zip Code:74447-0098
Mailing Address - Country:US
Mailing Address - Phone:986-509-5661
Mailing Address - Fax:
Practice Address - Street 1:23203 S 220 RD
Practice Address - Street 2:
Practice Address - City:HENRYETTA
Practice Address - State:OK
Practice Address - Zip Code:74437-7511
Practice Address - Country:US
Practice Address - Phone:918-650-9566
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-10-04
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OKD6243617367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered