Provider Demographics
NPI:1104617240
Name:MOSTELLER, ANDREA LA DAWN (BSN RN)
Entity type:Individual
Prefix:
First Name:ANDREA
Middle Name:LA DAWN
Last Name:MOSTELLER
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Gender:F
Credentials:BSN RN
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Mailing Address - Street 1:1011 HONOR HEIGHTS DR
Mailing Address - Street 2:
Mailing Address - City:MUSKOGEE
Mailing Address - State:OK
Mailing Address - Zip Code:74401-1318
Mailing Address - Country:US
Mailing Address - Phone:918-577-3121
Mailing Address - Fax:918-577-3256
Practice Address - Street 1:1011 HONOR HEIGHTS DR
Practice Address - Street 2:
Practice Address - City:MUSKOGEE
Practice Address - State:OK
Practice Address - Zip Code:74401-1318
Practice Address - Country:US
Practice Address - Phone:918-577-3121
Practice Address - Fax:918-577-3256
Is Sole Proprietor?:Yes
Enumeration Date:2025-05-16
Last Update Date:2025-05-16
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
OKR0062778163WX0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes163WX0200XNursing Service ProvidersRegistered NurseOncologyGroup - Multi-Specialty