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Contact Information

AGE ERASE MEDICAL AESTHETICS
7010 S UTICA AVE
TULSA, OK74136-3907
 Phone: 940-704-1700
 Fax:
 Website:
 

Specialty

Taxonomy Code Specialty Code Provider Type

Nurse Practitioner

363L00000X 50 Nurse Practitioner
 

Primary Care

261QP2300X
Indicates primary specialty

NPI Profile & details for AGE ERASE MEDICAL AESTHETICS

NPI # 1386505709
LBN Legal business name AGE ERASE MEDICAL AESTHETICS
Authorized official REESEY RUSSELL - (OWNER)
Entity Organization
Organization subpart 1 No
Enumeration date 11/24/2025
Last updated 03/04/2026 - About 3 months ago
Identifiers n/a
1 Some organization health care providers are made up of components that furnish different types of health care or have separate physical locations where health care is furnished. These components and physical locations are not themselves legal entities, but are part of the organization health care provider (which is a legal entity). A covered organization provider may decide that its subparts (if it has any) should have their own NPI numbers. If a subpart conducts any HIPAA standard transactions on its own (e.g., separately from its parent), it must obtain its own NPI number.

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