Provider Demographics
NPI:1568877793
Name:SROCZYNSKI, JILLENE MARIE (RN, BSN)
Entity Type:Individual
Prefix:
First Name:JILLENE
Middle Name:MARIE
Last Name:SROCZYNSKI
Suffix:
Gender:F
Credentials:RN, BSN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1400 E EAGLE NEST TER
Mailing Address - Street 2:
Mailing Address - City:MUSTANG
Mailing Address - State:OK
Mailing Address - Zip Code:73064-9442
Mailing Address - Country:US
Mailing Address - Phone:405-812-8719
Mailing Address - Fax:
Practice Address - Street 1:1400 E EAGLE NEST TER
Practice Address - Street 2:
Practice Address - City:MUSTANG
Practice Address - State:OK
Practice Address - Zip Code:73064-9442
Practice Address - Country:US
Practice Address - Phone:405-812-8719
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-06-26
Last Update Date:2014-06-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK113139163WC0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WC0200XNursing Service ProvidersRegistered NurseCritical Care Medicine