Provider Demographics
NPI:1750317319
Name:PASIERB, DOLORES (CRNA)
Entity Type:Individual
Prefix:
First Name:DOLORES
Middle Name:
Last Name:PASIERB
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 5978
Mailing Address - Street 2:
Mailing Address - City:ARDMORE
Mailing Address - State:OK
Mailing Address - Zip Code:73403
Mailing Address - Country:US
Mailing Address - Phone:580-226-5000
Mailing Address - Fax:580-226-5035
Practice Address - Street 1:2412 NORTH COMMERCE
Practice Address - Street 2:
Practice Address - City:ARDMORE
Practice Address - State:OK
Practice Address - Zip Code:73401
Practice Address - Country:US
Practice Address - Phone:580-226-5000
Practice Address - Fax:580-226-5035
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-06-24
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OKR0016566367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
OKP00074986OtherRAILROAD MEDICARE
OK731205988005OtherDEPT OF REHABILITATION