Provider Demographics
NPI:1881160356
Name:LANDERS, WANJIRU
Entity type:Individual
Prefix:
First Name:WANJIRU
Middle Name:
Last Name:LANDERS
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 1:705 S. VIRGINIA
Mailing Address - Street 2:WANJILAND@GMAIL.COM
Mailing Address - City:BARTLESVILLE
Mailing Address - State:OK
Mailing Address - Zip Code:74003-3847
Mailing Address - Country:US
Mailing Address - Phone:918-337-8080
Mailing Address - Fax:405-551-8445
Practice Address - Street 1:705 S VIRGINIA AVE
Practice Address - Street 2:
Practice Address - City:BARTLESVILLE
Practice Address - State:OK
Practice Address - Zip Code:74003-4439
Practice Address - Country:US
Practice Address - Phone:918-337-8080
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-10-22
Last Update Date:2025-07-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
OK5014363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program