Provider Demographics
NPI:1144697491
Name:CHANDLER, RUSSELL EARL (CRNA)
Entity type:Individual
Prefix:
First Name:RUSSELL
Middle Name:EARL
Last Name:CHANDLER
Suffix:
Gender:M
Credentials:CRNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2629 KADLAN DR
Mailing Address - Street 2:
Mailing Address - City:EL RENO
Mailing Address - State:OK
Mailing Address - Zip Code:73036-9405
Mailing Address - Country:US
Mailing Address - Phone:405-664-2836
Mailing Address - Fax:
Practice Address - Street 1:2629 KADLAN DR
Practice Address - Street 2:
Practice Address - City:EL RENO
Practice Address - State:OK
Practice Address - Zip Code:73036-9405
Practice Address - Country:US
Practice Address - Phone:405-664-2836
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-08-21
Last Update Date:2015-11-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK71120367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered