Provider Demographics
NPI:1932193422
Name:HOLBROOK, MONA LEA (CRNA)
Entity Type:Individual
Prefix:
First Name:MONA
Middle Name:LEA
Last Name:HOLBROOK
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 1:216 FOREMAN CIR
Mailing Address - Street 2:
Mailing Address - City:NORMAN
Mailing Address - State:OK
Mailing Address - Zip Code:73069-6614
Mailing Address - Country:US
Mailing Address - Phone:405-307-0548
Mailing Address - Fax:405-307-9831
Practice Address - Street 1:216 FOREMAN CIR
Practice Address - Street 2:
Practice Address - City:NORMAN
Practice Address - State:OK
Practice Address - Zip Code:73069-6614
Practice Address - Country:US
Practice Address - Phone:405-307-0548
Practice Address - Fax:405-307-9831
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-09-12
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OKR0024073367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered