Provider Demographics
NPI:1952335473
Name:GRISHAM, RHONDA PARKER (CRNA)
Entity Type:Individual
Prefix:
First Name:RHONDA
Middle Name:PARKER
Last Name:GRISHAM
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 1:4808 S 109TH EAST AVE
Mailing Address - Street 2:
Mailing Address - City:TULSA
Mailing Address - State:OK
Mailing Address - Zip Code:74146-5822
Mailing Address - Country:US
Mailing Address - Phone:918-742-2502
Mailing Address - Fax:918-745-9750
Practice Address - Street 1:4737 S 209TH WEST AVE
Practice Address - Street 2:
Practice Address - City:SAND SPRINGS
Practice Address - State:OK
Practice Address - Zip Code:74063-4656
Practice Address - Country:US
Practice Address - Phone:918-408-8151
Practice Address - Fax:918-745-9750
Is Sole Proprietor?:No
Enumeration Date:2006-07-10
Last Update Date:2021-04-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OKR0084504367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK900522349OtherMEDICARE GROUP PIN
OK200091060AMedicaid
OK247804601Medicare PIN