Individual
ANASTASIA DEROUSSEL
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
NP
Contact information
Practice address
1202 W CHEROKEE ST STE G, WAGONER, OK 74467-4629
(918) 914-5533
(918) 485-6020
Mailing address
1200 W CHEROKEE ST, WAGONER, OK 74467-4624
(918) 485-5514
Taxonomy
Speciality
Code
Description
License number
State
163W00000X
Registered Nurse
727314-1
NY
363LF0000X
Family Nurse Practitioner
F341382-1
NY
363LF0000X
Family Nurse Practitioner
Primary
R0129494
OK
363LG0600X
Gerontology Nurse Practitioner
R0129494
OK
Other
Enumeration date
04/06/2017
Last updated
03/10/2023
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