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NICHOLAS TYLER RUSSENBERGER

Active
Sole proprietor
No

Provider details

NPI number
Gender
Man
Credential
MPAS

Contact information

Practice address
1003 US HIGHWAY 64, BUFFALO, OK 73834-8912
(580) 735-2555
(580) 735-2574
Mailing address
PO BOX 677, BUFFALO, OK 73834-0677
(501) 215-1468

Taxonomy

Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
5175
OK

Other

Enumeration date
10/10/2023
Last updated
10/10/2023
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