Provider Demographics
NPI:1699437012
Name:PERMETTER, ANGLIC MARIE
Entity type:Individual
Prefix:
First Name:ANGLIC
Middle Name:MARIE
Last Name:PERMETTER
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:808 S PEORIA AVE
Mailing Address - Street 2:
Mailing Address - City:TULSA
Mailing Address - State:OK
Mailing Address - Zip Code:74120-4427
Mailing Address - Country:US
Mailing Address - Phone:918-560-1300
Mailing Address - Fax:918-560-1399
Practice Address - Street 1:808 S PEORIA AVE
Practice Address - Street 2:
Practice Address - City:TULSA
Practice Address - State:OK
Practice Address - Zip Code:74120-4427
Practice Address - Country:US
Practice Address - Phone:918-560-1300
Practice Address - Fax:918-560-1399
Is Sole Proprietor?:No
Enumeration Date:2021-10-13
Last Update Date:2021-10-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator