Russell, Connie
Russell, Connie is an sole proprietor health care provider with primary practice located at 502 S Choctaw Ave , Wapanucka OK 73461-9235. She recently has only one registered license in Agencies / Public Health or Welfare, which is considered as her primary health care specialty. Russell, Connie can be contacted via phone (580) 937-4288.Contact Information
Primary practice address
502 S Choctaw Ave
Wapanucka OK 73461-9235
Phone: (580) 937-4288
Fax: (580) 937-4804
Website:
Health care specialties
| Specialty | Code | License # | State |
|---|---|---|---|
| Agencies / Public Health or Welfare | 251K00000X |
Profile Details
| NPI number | 1649630856 |
|---|---|
| LBN Legal business name | Russell, Connie |
| Credentials | |
| Entity | Individual |
| Sole proprietor 1 | Yes |
| Enumeration date | Mar 1st, 2016 |
| Last updated | Mar 1st, 2016 - about 9 years ago |
1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.
Identifiers
| State | Type | Number | Issuer |
|---|---|---|---|
| All States | NPI | 1649630856 | NPPES |
| Oklahoma | MEDICAID | 100687480A |
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