Provider Demographics
NPI:1285484253
Name:AYANA MEDICAL SERVICES LLC
Entity type:Organization
Organization Name:AYANA MEDICAL SERVICES LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:FAMILY NURSE PRACTITIONER
Authorized Official - Prefix:
Authorized Official - First Name:CAROLYNE
Authorized Official - Middle Name:
Authorized Official - Last Name:BANGURAH
Authorized Official - Suffix:
Authorized Official - Credentials:CNP
Authorized Official - Phone:405-445-9555
Mailing Address - Street 1:600 N WALKER AVE STE 103
Mailing Address - Street 2:
Mailing Address - City:OKLAHOMA CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73102-3035
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:866-728-2564
Practice Address - Street 1:600 N WALKER AVE STE 103
Practice Address - Street 2:
Practice Address - City:OKLAHOMA CITY
Practice Address - State:OK
Practice Address - Zip Code:73102-3035
Practice Address - Country:US
Practice Address - Phone:405-445-9555
Practice Address - Fax:866-728-2564
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-03-25
Last Update Date:2024-03-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Single Specialty