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Organization
AGE ERASE MEDICAL AESTHETICS
Active
Organization
AGE ERASE MEDICAL AESTHETICS
Active
Organization subpart
No
Provider details
NPI number
Authorized official
REESEY RUSSELL APRN (OWNER)
(940) 704-1700
Entity
Organization
Contact information
Practice address
7010 S UTICA AVE, TULSA, OK 74136-3907
(940) 704-1700
Mailing address
7010 S UTICA AVE, TULSA, OK 74136-3907
(918) 890-4133
Taxonomy
Speciality
Code
Description
License number
State
261QP2300X
Primary Care Clinic/Center
—
NULL
363L00000X
Nurse Practitioner
Primary
—
NULL
363L00000X
Nurse Practitioner
Primary
—
—
Other
Enumeration date
11/24/2025
Last updated
03/04/2026
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