Healthcare Provider Details

I. General information

NPI: 1922349489
Provider Name (Legal Business Name): SVETLANA A PLYUSHKO BS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/08/2013
Last Update Date: 03/08/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2448 E. 81ST STREET SUITE 5125
TULSA OK
74137-4213
US

IV. Provider business mailing address

7413 S HICKORY AVE
BROKEN ARROW OK
74011-6046
US

V. Phone/Fax

Practice location:
  • Phone: 918-392-7875
  • Fax: 800-260-7966
Mailing address:
  • Phone: 918-392-7875
  • Fax: 800-206-7966

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225C00000X
TaxonomyRehabilitation Counselor
License NumberTRAINING IN PROCESS
License Number StateOK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: