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General NPI Number Information
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NPI Number | 1629861133
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Entity Type | Individual
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Provider Name | ALESIA LANDIS RN
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Gender | Female
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Dates
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Enumeration Date | 05/27/2025
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Last Update Date | 05/27/2025
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Provider Practice Location Address
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Address Line | 10159 E 11TH ST
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City | TULSA
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State | OK
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Zip | 74128-3058
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Country | US
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Telephone | 918-384-4547
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Fax | 918-384-4699
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Provider Business Mailing Address
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Address Line | 700 E QUINTON ST
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City | BROKEN ARROW
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State | OK
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Zip | 74011-8844
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Country | US
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Telephone | 918-260-0698
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 163WC1500X
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Taxonomy Name | Community Health Registered Nurse
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License Number | 67253
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License Number State | OK
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