Most Relevant Information
Provider Data
| NPI Number: | 1003480237 |
| Provider Name: | VANESSA DICUS APRN-CNP |
| Entity Type: | Individual |
| Taxonomy Code: | 363LF0000X |
| Specialty: | Nurse Practitioner |
| License Number: | R0122192 |
Most Important Dates
| Enumeration Date: | 05/12/2021 |
| Last Updated: | 05/12/2022 |
Provider Practice Location
20567 E KAMBRIE RD
INOLA
OK
740365334
Practice Location Phone/Fax
| Phone: | 4056596711 |
| Fax: |
Provider Mailing Location
20672 E KAMBRIE RD
INOLA
OK
740365349
Provider Mailing Phone/Fax
| Phone: | 4056596711 |
| Fax: |