Individual
ANASTACIA ROSETTA RIVERS
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
LPN
Contact information
Practice address
523 SW 11TH ST, LAWTON, OK 73501-4701
(915) 433-5801
Mailing address
523 SW 11TH ST, LAWTON, OK 73501-4701
(915) 433-5801
Taxonomy
Speciality
Code
Description
License number
State
164W00000X
Licensed Practical Nurse
Primary
LPN096160
OK
Other
Enumeration date
03/21/2021
Last updated
03/21/2021
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