Individual
TAYLOR RENEE RUSSELL
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
1202 W CHEROKEE ST STE E, WAGONER, OK 74467-4629
(918) 485-1877
Mailing address
1202 W CHEROKEE ST STE E, WAGONER, OK 74467-4629
(918) 485-1877
Taxonomy
Speciality
Code
Description
License number
State
363LF0000X
Family Nurse Practitioner
Primary
201054
OK
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
200979620A
—
OK
Enumeration date
03/26/2021
Last updated
06/03/2021
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