Provider Demographics
NPI:1265564439
Name:HILST, STEPHANIE M (CRNA)
Entity type:Individual
Prefix:
First Name:STEPHANIE
Middle Name:M
Last Name:HILST
Suffix:
Gender:F
Credentials:CRNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:4500 S GARNETT RD
Mailing Address - Street 2:STE 300
Mailing Address - City:TULSA
Mailing Address - State:OK
Mailing Address - Zip Code:74146-5229
Mailing Address - Country:US
Mailing Address - Phone:918-664-9892
Mailing Address - Fax:918-392-2945
Practice Address - Street 1:4500 S GARNETT RD
Practice Address - Street 2:STE 919
Practice Address - City:TULSA
Practice Address - State:OK
Practice Address - Zip Code:74146-5229
Practice Address - Country:US
Practice Address - Phone:918-664-9892
Practice Address - Fax:918-392-2945
Is Sole Proprietor?:No
Enumeration Date:2007-03-12
Last Update Date:2008-10-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OKR0047515367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK203690446001OtherBCBS
OK200105340AMedicaid
OK200105340AMedicaid
OK242721904Medicare PIN