Provider Demographics
NPI:1609392505
Name:BJORNSON, SUZANNE STELLA (APRN)
Entity Type:Individual
Prefix:
First Name:SUZANNE
Middle Name:STELLA
Last Name:BJORNSON
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5803 E 21ST PL
Mailing Address - Street 2:
Mailing Address - City:TULSA
Mailing Address - State:OK
Mailing Address - Zip Code:74114-2311
Mailing Address - Country:US
Mailing Address - Phone:918-740-7540
Mailing Address - Fax:
Practice Address - Street 1:10810 E 45TH ST STE 400
Practice Address - Street 2:
Practice Address - City:TULSA
Practice Address - State:OK
Practice Address - Zip Code:74146-3806
Practice Address - Country:US
Practice Address - Phone:918-742-7030
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-08-22
Last Update Date:2017-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK108276363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner