Individual
MRS. ANGEL NICOLE RUSSELL
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
ED.S
Contact information
Practice address
35 NE 67TH ST, OKLAHOMA CITY, OK 73105-1238
(405) 514-0484
Mailing address
35 NE 67TH ST, OKLAHOMA CITY, OK 73105-1238
(405) 514-0484
Taxonomy
Speciality
Code
Description
License number
State
103K00000X
Behavior Analyst
Primary
—
OK
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
200330980
—
OK
Enumeration date
04/20/2012
Last updated
05/24/2012
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