Individual
TAMERA RUSSELL
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
304 S 29TH ST, CHICKASHA, OK 73018-2501
(405) 896-8058
Mailing address
304 S 29TH ST, CHICKASHA, OK 73018-2501
Taxonomy
Speciality
Code
Description
License number
State
164W00000X
Licensed Practical Nurse
Primary
55586
OK
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
55586
OK 55586
OK
Enumeration date
12/08/2015
Last updated
12/08/2015
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