Provider Demographics
NPI:1871351221
Name:STASILLI, ANNALOU
Entity type:Individual
Prefix:
First Name:ANNALOU
Middle Name:
Last Name:STASILLI
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15520 ALLEGHENY DR
Mailing Address - Street 2:
Mailing Address - City:EDMOND
Mailing Address - State:OK
Mailing Address - Zip Code:73013-8826
Mailing Address - Country:US
Mailing Address - Phone:405-520-5749
Mailing Address - Fax:
Practice Address - Street 1:832 ISABEL ST
Practice Address - Street 2:
Practice Address - City:ARDMORE
Practice Address - State:OK
Practice Address - Zip Code:73401-5118
Practice Address - Country:US
Practice Address - Phone:405-986-9245
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-03-11
Last Update Date:2024-08-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK99396163WC0400X
OK218602364SL0600X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes364SL0600XPhysician Assistants & Advanced Practice Nursing ProvidersClinical Nurse SpecialistLong-Term Care
No163WC0400XNursing Service ProvidersRegistered NurseCase Management