Organization
RESURGENCE VITALITY, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
ANGELA C. BAUSTERT DNP, APRN (OWNER/NURSE PRACTITIONER)
(405) 216-3437
Entity
Organization
Contact information
Practice address
2901 FAIRFAX DR STE 100, EDMOND, OK 73034-3521
(405) 216-3437
(866) 497-6393
Mailing address
2901 FAIRFAX DR STE 100, EDMOND, OK 73034-3521
(405) 216-3437
(866) 497-6393
Taxonomy
Speciality
Code
Description
License number
State
261QH0100X
Health Service Clinic/Center
Primary
—
—
261QM2500X
Medical Specialty Clinic/Center
—
—
Other
Enumeration date
08/28/2025
Last updated
09/09/2025
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