Healthcare Provider Details

I. General information

NPI: 1699298521
Provider Name (Legal Business Name): ANGELA MICHELLE MARIANI NURSE PRACTITIONER
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/23/2017
Last Update Date: 09/03/2024
Certification Date: 08/28/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8806 S YALE AVE STE B
TULSA OK
74137-3712
US

IV. Provider business mailing address

3355 W 103RD ST N
SPERRY OK
74073-4131
US

V. Phone/Fax

Practice location:
  • Phone: 918-710-2062
  • Fax: 918-710-4421
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number98833
License Number StateOK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: