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General NPI Number Information
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NPI Number | 1932088440
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Entity Type | Organization
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Legal Business Name | RESURGENCE VITALITY, LLC
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Dates
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Enumeration Date | 08/28/2025
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Last Update Date | 09/09/2025
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Provider Practice Location Address
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Address Line | 2901 FAIRFAX DR STE 100
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City | EDMOND
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State | OK
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Zip | 73034-3521
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Country | US
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Telephone | 405-216-3437
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Fax | 866-497-6393
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Provider Business Mailing Address
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Address Line | 2901 FAIRFAX DR STE 100
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City | EDMOND
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State | OK
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Zip | 73034-3521
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Country | US
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Telephone | 405-216-3437
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Fax | 866-497-6393
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Authorized Official
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Title or Position | OWNER/NURSE PRACTITIONER
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Name | ANGELA C. BAUSTERT
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Credential | DNP, APRN
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Telephone | 405-216-3437
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QM2500X
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Taxonomy Name | Medical Specialty Clinic/Center
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 261QH0100X
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Taxonomy Name | Health Service Clinic/Center
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License Number |
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License Number State |
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