Individual
DONNA ANDERSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA
Contact information
Practice address
1124 S SAINT LOUIS AVE, TULSA, OK 74120-5413
(918) 592-0296
(918) 592-0286
Mailing address
1124 S SAINT LOUIS AVE, TULSA, OK 74120-5413
(918) 592-0296
(918) 592-0286
Taxonomy
Speciality
Code
Description
License number
State
363AM0700X
Medical Physician Assistant
Primary
314
OK
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
100717240B
—
OK
Enumeration date
11/29/2006
Last updated
08/16/2013
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