Provider Information for 1578570305
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Dr. ANITA JEANNE RUSSELL Ed.D.
Sex: Female
NPI: 1578570305
Last Updated: 2011-10-27
Certification Date:
Certification Date:
Details
| Name | Value | ||||||||
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| NPI | 1578570305 | ||||||||
| Enumeration Date | 2006-08-02 | ||||||||
| NPI Type | NPI-1 Individual | ||||||||
| Sole Proprietor | YES | ||||||||
| Status | Active | ||||||||
| Mailing Address | 4203 E 75TH PL TULSA, OK 74136-6126 United States Phone: 918-671-7960 | Fax:918-728-8387 | ||||||||
| Primary Practice Address | 3314 E 51ST ST SUITE 204F TULSA, OK 74135-3583 United States Phone: 918-671-7960 | Fax:918-728-8387 | ||||||||
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