Provider Demographics
NPI:1841460714
Name:MILLS, ANNETTE CLAIR (CRNA)
Entity type:Individual
Prefix:
First Name:ANNETTE
Middle Name:CLAIR
Last Name:MILLS
Suffix:
Gender:
Credentials:CRNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:18780 S HICKORY PL
Mailing Address - Street 2:
Mailing Address - City:CLAREMORE
Mailing Address - State:OK
Mailing Address - Zip Code:74019-0378
Mailing Address - Country:US
Mailing Address - Phone:918-640-1652
Mailing Address - Fax:
Practice Address - Street 1:111 N BAILEY ST
Practice Address - Street 2:
Practice Address - City:PRYOR
Practice Address - State:OK
Practice Address - Zip Code:74361-4201
Practice Address - Country:US
Practice Address - Phone:918-824-7791
Practice Address - Fax:918-824-6316
Is Sole Proprietor?:No
Enumeration Date:2008-03-07
Last Update Date:2025-03-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY731884367500000X
OKR0088519367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK100700040EMedicaid
OK200203250AMedicaid
OK100700040EMedicaid
OK200203250AMedicaid