Individual
MRS. STEPHANIE ANN RUSSELL
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
RN, LMT
Contact information
Practice address
35266 W HWY 33, MANNFORD, OK 74044
(918) 330-3835
Mailing address
PO BOX 1851, MANNFORD, OK 74044-1851
(918) 330-3835
Taxonomy
Speciality
Code
Description
License number
State
163W00000X
Registered Nurse
R132210
OK
225700000X
Massage Therapist
Primary
190284-0
OK
Other
Enumeration date
03/30/2022
Last updated
03/30/2022
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