Healthcare Provider Details

I. General information

NPI: 1881160356
Provider Name (Legal Business Name): WANJIRU LANDERS
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/22/2018
Last Update Date: 07/25/2025
Certification Date: 07/17/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

705 S VIRGINIA AVE
BARTLESVILLE OK
74003-4439
US

IV. Provider business mailing address

705 S. VIRGINIA WANJILAND@GMAIL.COM
BARTLESVILLE OK
74003-3847
US

V. Phone/Fax

Practice location:
  • Phone: 918-337-8080
  • Fax:
Mailing address:
  • Phone: 918-337-8080
  • Fax: 405-551-8445

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number5014
License Number StateOK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: