1346367653 NPI number — ELIZABETH SCHNATTERER MANIS RD,LD,CDE

Table of content: ELIZABETH SCHNATTERER MANIS RD,LD,CDE (NPI 1346367653)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1346367653 NPI number — ELIZABETH SCHNATTERER MANIS RD,LD,CDE

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
MANIS
Provider First Name:
ELIZABETH
Provider Middle Name:
SCHNATTERER
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
RD,LD,CDE
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
MANIS
Provider Other First Name:
BETSY
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
RD,LD,CDE
Provider Other Last Name Type Code:
5

NPI Number Information

NPI Number:
1346367653
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/08/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
2117 E 25TH PL
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
TULSA
Provider Business Mailing Address State Name:
OK
Provider Business Mailing Address Postal Code:
74114-2917
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
918-744-1130
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1265 S UTICA AVE
Provider Second Line Business Practice Location Address:
SUITE 100
Provider Business Practice Location Address City Name:
TULSA
Provider Business Practice Location Address State Name:
OK
Provider Business Practice Location Address Postal Code:
74104-4243
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
918-579-3384
Provider Business Practice Location Address Fax Number:
918-579-3305
Provider Enumeration Date:
03/23/2007

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 133V00000X , with the licence number:  541 , registered in the state of OK ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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