Basic Information
| Provider Information | |||||||||
| NPI: | 1235211319 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | AFSHARI | ||||||||
| FirstName: | SYAVOSH | ||||||||
| MiddleName: | |||||||||
| NamePrefix: | MR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | CRNFA | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1145 S. UTICA AVENUE | ||||||||
| Address2: | SUITE 110 | ||||||||
| City: | TULSA | ||||||||
| State: | OK | ||||||||
| PostalCode: | 741044013 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9185793826 | ||||||||
| FaxNumber: | 9185791262 | ||||||||
| Practice Location | |||||||||
| Address1: | 1265 S. UTICA AVE. | ||||||||
| Address2: | SUITE 105 | ||||||||
| City: | TULSA | ||||||||
| State: | OK | ||||||||
| PostalCode: | 741044243 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9187496400 | ||||||||
| FaxNumber: | 9187492168 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 10/19/2006 | ||||||||
| LastUpdateDate: | 05/15/2009 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 163WR0006X | R0048267 | OK | Y | Nursing Service Providers | Registered Nurse | Registered Nurse First Assistant |
ID Information
| ID | Type | State | Issuer | Description | R0048267 | 01 | OK | NURSING LICENSE | OTHER |