Healthcare Provider Details

I. General information

NPI: 1376926204
Provider Name (Legal Business Name): GINGER LANYE D.V.M.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/09/2015
Last Update Date: 07/09/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6319 S ELM PL
BROKEN ARROW OK
74011-4101
US

IV. Provider business mailing address

6319 S ELM PL
BROKEN ARROW OK
74011-4101
US

V. Phone/Fax

Practice location:
  • Phone: 918-451-1440
  • Fax:
Mailing address:
  • Phone: 918-451-1440
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174M00000X
TaxonomyVeterinarian
License Number4460
License Number StateOK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: