Individual
MAEGAN RENEE' RUSSELL
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
APRN-CNP
Contact information
Practice address
1921 STONECIPHER DR, ADA, OK 74820-3439
(580) 436-3980
Mailing address
300 RAY STOUT BLVD, ADA, OK 74820-1908
Taxonomy
Speciality
Code
Description
License number
State
163WG0000X
General Practice Registered Nurse
R0122451
OK
363LF0000X
Family Nurse Practitioner
Primary
204854
OK
Other
Enumeration date
08/04/2021
Last updated
08/04/2021
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