Russell, Taylor Renee
Russell, Taylor Renee is an individual health care provider with primary practice located at 1202 W Cherokee St Ste E , Wagoner OK 74467-4629. She recently has only one registered license in Physician Assistants & Advanced Practice Nursing Providers / Family, which is considered as her primary health care specialty. Russell, Taylor Renee can be contacted via phone (918) 485-1877.Contact Information
Primary practice address
1202 W Cherokee St Ste E
Wagoner OK 74467-4629
Phone: (918) 485-1877
Fax:
Website:
Health care specialties
| Specialty | Code | License # | State |
|---|---|---|---|
| Physician Assistants & Advanced Practice Nursing Providers / Family | 363LF0000X | 201054 | Oklahoma |
Profile Details
| NPI number | 1881271864 |
|---|---|
| LBN Legal business name | Russell, Taylor Renee |
| Credentials | |
| Entity | Individual |
| Sole proprietor 1 | No |
| Enumeration date | Mar 26th, 2021 |
| Last updated | Jun 3rd, 2021 - about 4 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 | 1881271864 | NPPES |
| Oklahoma | MEDICAID | 200979620A |
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