Individual
JENNIFER RUSSELL
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
12777 N ROCKWELL AVE, OKLAHOMA CITY, OK 73142-2710
(405) 717-7740
Mailing address
21907 TOSCANA CT, EDMOND, OK 73012-0919
(405) 623-2326
Taxonomy
Speciality
Code
Description
License number
State
364SF0001X
Family Health Clinical Nurse Specialist
Primary
94676
OK
Other
Enumeration date
12/09/2014
Last updated
07/21/2022
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