OrganizationActive
Age Erase Medical Aesthetics
NPI 1386505709 · Nurse Practitioner · Tulsa, OK
Provider details
- NPI number
- 1386505709
- Entity type
- Organization
- Primary specialty
- Nurse PractitionerPhysician Assistants & Advanced Practice Nursing Providers
- Organization subpart
- No
- Authorized official
- Reesey Russell, Owner(940) 704-1700
Specialties & taxonomies
Physician Assistants & Advanced Practice Nursing Providers
- Primary Care Clinic/Center261QP2300X
Ambulatory Health Care Facilities
Practice location
7010 S Utica Ave
Tulsa, OK 74136-3907
Phone: (940) 704-1700
Approximate (ZIP-level) locationGet directions
Mailing address
7010 S Utica Ave
Tulsa, OK 74136-3907
Registry dates
- Enumerated
- 2025-11-24
- Last updated
- 2026-03-04
- Certified
- 2026-03-04
Source: CMS NPPES Data Dissemination (June 2026). NPI Central is not affiliated with CMS. Data is provided as-is from the public registry.