1144656331 NPI number — MS. SHAUN CARRICK BARANOWSKI APRN-CNM

Table of content: MS. SHAUN CARRICK BARANOWSKI APRN-CNM (NPI 1144656331)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1144656331 NPI number — MS. SHAUN CARRICK BARANOWSKI APRN-CNM

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
BARANOWSKI
Provider First Name:
SHAUN
Provider Middle Name:
CARRICK
Provider Name Prefix Text:
MS.
Provider Name Suffix Text:
Provider Credential Text:
APRN-CNM
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
LESSER
Provider Other First Name:
SHAUN
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
APRN-CNM
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1144656331
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
01/10/2022
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
5310 E 31ST ST FL 13
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
TULSA
Provider Business Mailing Address State Name:
OK
Provider Business Mailing Address Postal Code:
74135-5018
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
918-561-5701
Provider Business Mailing Address Fax Number:
918-561-1173

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
717 S HOUSTON AVE STE 200
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
TULSA
Provider Business Practice Location Address State Name:
OK
Provider Business Practice Location Address Postal Code:
74127-9005
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
918-586-4500
Provider Business Practice Location Address Fax Number:
918-586-4528
Provider Enumeration Date:
09/19/2013

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 367A00000X , with the licence number:  92717 , registered in the state of OK ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 200515500A , issued by the state of ( OK ) . This identifiers is of the category "MEDICAID".
  • Identifier: 1X5106 . This is a "MEDICARE" identifier , issued by the state of ( OK ) . This identifiers is of the category "OTHER".