Provider Demographics
NPI:1144656331
Name:BARANOWSKI, SHAUN CARRICK (APRN-CNM)
Entity type:Individual
Prefix:MS
First Name:SHAUN
Middle Name:CARRICK
Last Name:BARANOWSKI
Suffix:
Gender:F
Credentials:APRN-CNM
Other - Prefix:
Other - First Name:SHAUN
Other - Middle Name:
Other - Last Name:LESSER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:APRN-CNM
Mailing Address - Street 1:5310 E 31ST ST FL 13
Mailing Address - Street 2:
Mailing Address - City:TULSA
Mailing Address - State:OK
Mailing Address - Zip Code:74135-5018
Mailing Address - Country:US
Mailing Address - Phone:918-561-5701
Mailing Address - Fax:918-561-1173
Practice Address - Street 1:717 S HOUSTON AVE STE 200
Practice Address - Street 2:
Practice Address - City:TULSA
Practice Address - State:OK
Practice Address - Zip Code:74127-9005
Practice Address - Country:US
Practice Address - Phone:918-586-4500
Practice Address - Fax:918-586-4528
Is Sole Proprietor?:No
Enumeration Date:2013-09-19
Last Update Date:2022-01-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK92717367A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367A00000XPhysician Assistants & Advanced Practice Nursing ProvidersAdvanced Practice Midwife
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK200515500AMedicaid
OK1X5106OtherMEDICARE