Individual
TIONNA SHARELL RUSSELL
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
9450 E 48TH PL APT 137F, TULSA, OK 74145-7357
(539) 292-6612
Mailing address
9450 E 48TH PL APT 137F, TULSA, OK 74145-7357
(539) 292-6612
Taxonomy
Speciality
Code
Description
License number
State
175T00000X
Peer Specialist
Primary
082261035
OK
Other
Enumeration date
05/07/2024
Last updated
05/07/2024
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