Richard N Fortune, CRNA
Individual provider Active NPI Certified Registered Nurse Anesthetist · Geronimo, OK
NPI 1760475412 · NPPES record last updated Jul 8, 2007
Key facts
- NPI
- 1760475412
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Certified Registered Nurse Anesthetist 367500000X
- License
- R0048255 (OK)
- Practice address
- 412 SW Landmark Circle
Geronimo, OK 73543 - Phone
- (580) 357-8198
- NPI assigned
- Aug 29, 2005
- Sex
- Male
- Sole proprietor
- Yes
Organizations & group practices 1
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- Yes
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| R0048255 | OK | MD | Certified Registered Nurse Anesthetist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Northstar Anesthesia of Oklahoma, PLLC | Past | Accepting new patients |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Certified Registered Nurse Anesthetist | 367500000X | R0048255 | OK | Yes |
Addresses
Primary practice location
412 SW Landmark Circle
Geronimo, OK 73543
Mailing address
412 SW Landmark Circle
Geronimo, OK 73543
Phone (580) 357-8198
Other providers in Geronimo, OK
- Champion Chiropractic PLLC
- Richard Riley Cizek
- Michelle Mozelle Fite
- Geronimo Public School
- Sierra Quinn
- Richard Neil Fortune Crna PC
- Denise Loretta Ronan
All providers in Geronimo, OK · Certified Registered Nurse Anesthetist in Oklahoma
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Jul 8, 2007. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.