Individual
ANA RUSSELL
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
1515 NE LAWRIE TATUM RD, LAWTON, OK 73507-3002
(580) 354-5396
Mailing address
1515 NE LAWRIE TATUM RD, LAWTON, OK 73507-3002
Taxonomy
Speciality
Code
Description
License number
State
163WM0705X
Medical-Surgical Registered Nurse
Primary
R0133667
OK
Other
Enumeration date
11/26/2021
Last updated
11/26/2021
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