Provider Demographics
NPI:1962647800
Name:DECK, ROBIN J (CRNA)
Entity Type:Individual
Prefix:
First Name:ROBIN
Middle Name:J
Last Name:DECK
Suffix:
Gender:F
Credentials:CRNA
Other - Prefix:
Other - First Name:ROBIN
Other - Middle Name:J
Other - Last Name:BRUCE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 248875
Mailing Address - Street 2:
Mailing Address - City:OKLAHOMA CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73124-8875
Mailing Address - Country:US
Mailing Address - Phone:918-392-2944
Mailing Address - Fax:918-664-2521
Practice Address - Street 1:5501 N PORTLAND AVE
Practice Address - Street 2:
Practice Address - City:OKLAHOMA CITY
Practice Address - State:OK
Practice Address - Zip Code:73112-2074
Practice Address - Country:US
Practice Address - Phone:918-664-9892
Practice Address - Fax:918-664-2521
Is Sole Proprietor?:No
Enumeration Date:2008-12-05
Last Update Date:2014-01-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OKR0068461367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK200227040AMedicaid
P00714515OtherRAILROAD MEDICARE
OK200227040AMedicaid