Healthcare Provider Details

I. General information

NPI: 1508788332
Provider Name (Legal Business Name): AIDAN G HANEY
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/25/2026
Last Update Date: 07/25/2026
Certification Date: 07/25/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2325 S HARVARD AVE
TULSA OK
74114-3301
US

IV. Provider business mailing address

5136 S MADISON AVE
TULSA OK
74105-5622
US

V. Phone/Fax

Practice location:
  • Phone: 918-891-2595
  • Fax:
Mailing address:
  • Phone: 575-317-3166
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code175T00000X
TaxonomyPeer Specialist
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: