Provider Demographics
NPI:1669238465
Name:ANDERSON, MILISSE (PHLEBOTOMIST)
Entity type:Individual
Prefix:
First Name:MILISSE
Middle Name:
Last Name:ANDERSON
Suffix:
Gender:F
Credentials:PHLEBOTOMIST
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:165 WOODRING ST
Mailing Address - Street 2:
Mailing Address - City:ALTUS
Mailing Address - State:OK
Mailing Address - Zip Code:73521-7410
Mailing Address - Country:US
Mailing Address - Phone:580-481-4784
Mailing Address - Fax:
Practice Address - Street 1:165 WOODRING ST
Practice Address - Street 2:
Practice Address - City:ALTUS
Practice Address - State:OK
Practice Address - Zip Code:73521-7410
Practice Address - Country:US
Practice Address - Phone:580-481-4784
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-02-28
Last Update Date:2024-02-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK155340S55447K56146246RP1900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes246RP1900XTechnologists, Technicians & Other Technical Service ProvidersTechnician, PathologyPhlebotomyGroup - Single Specialty