Healthcare Provider Details

I. General information

NPI: 1275518367
Provider Name (Legal Business Name): VALERIE B MANNING DO PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/12/2005
Last Update Date: 08/31/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3330 NW 56TH ST SUITE 305
OKLAHOMA CITY OK
73112-4479
US

IV. Provider business mailing address

3330 NW 56TH STREET SUITE 305
OKLAHOMA CITY OK
73112-4426
US

V. Phone/Fax

Practice location:
  • Phone: 405-945-5240
  • Fax: 405-945-5263
Mailing address:
  • Phone: 405-945-5240
  • Fax: 405-945-5263

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207QA0505X
TaxonomyAdult Medicine Physician
License Number3811
License Number StateOK

VIII. Authorized Official

Name: DR. VALERIE B MANNING
Title or Position: PHYSICIAN
Credential: DO
Phone: 405-945-5240