Provider Demographics
NPI:1316832280
Name:MORTENSEN, CARRIE (RN)
Entity type:Individual
Prefix:
First Name:CARRIE
Middle Name:
Last Name:MORTENSEN
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1924 S UTICA AVE STE 400
Mailing Address - Street 2:
Mailing Address - City:TULSA
Mailing Address - State:OK
Mailing Address - Zip Code:74104-6510
Mailing Address - Country:US
Mailing Address - Phone:918-212-4694
Mailing Address - Fax:
Practice Address - Street 1:1924 S UTICA AVE STE 400
Practice Address - Street 2:
Practice Address - City:TULSA
Practice Address - State:OK
Practice Address - Zip Code:74104-6510
Practice Address - Country:US
Practice Address - Phone:918-212-4694
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-06-11
Last Update Date:2025-06-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OKR0089036163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse