Healthcare Provider Details

I. General information

NPI: 1104617240
Provider Name (Legal Business Name): ANDREA LA DAWN MOSTELLER BSN RN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/16/2025
Last Update Date: 05/16/2025
Certification Date: 05/16/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1011 HONOR HEIGHTS DR
MUSKOGEE OK
74401-1318
US

IV. Provider business mailing address

1011 HONOR HEIGHTS DR
MUSKOGEE OK
74401-1318
US

V. Phone/Fax

Practice location:
  • Phone: 918-577-3121
  • Fax: 918-577-3256
Mailing address:
  • Phone: 918-577-3121
  • Fax: 918-577-3256

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WX0200X
TaxonomyOncology Registered Nurse
License NumberR0062778
License Number StateOK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: