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General NPI Number Information
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NPI Number | 1912275157
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Entity Type | Individual
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Provider Name | LANNY SETIAWAN
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Gender | Female
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Dates
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Enumeration Date | 12/02/2011
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Last Update Date | 12/02/2011
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Provider Practice Location Address
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Address Line | 2448 E 81ST STREET SUITE 4824
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City | TULSA
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State | OK
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Zip | 74137-4320
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Country | US
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Telephone | 918-392-7875
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Fax |
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Provider Business Mailing Address
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Address Line | 6212 E 72ND STREET APT 829
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City | TULSA
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State | OK
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Zip | 74136-6945
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Country | US
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Telephone | 918-859-4035
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 225400000X
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Taxonomy Name | Rehabilitation Practitioner
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License Number |
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License Number State |
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