Provider Demographics
NPI:1962928929
Name:HANNEMAN, TANYA SHANTEL (RN)
Entity type:Individual
Prefix:MRS
First Name:TANYA
Middle Name:SHANTEL
Last Name:HANNEMAN
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1717B S UTICA AVE STE 205
Mailing Address - Street 2:
Mailing Address - City:TULSA
Mailing Address - State:OK
Mailing Address - Zip Code:74104-5332
Mailing Address - Country:US
Mailing Address - Phone:918-744-2916
Mailing Address - Fax:
Practice Address - Street 1:1717B S UTICA AVE STE 205
Practice Address - Street 2:
Practice Address - City:TULSA
Practice Address - State:OK
Practice Address - Zip Code:74104-5332
Practice Address - Country:US
Practice Address - Phone:918-744-2444
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-08-21
Last Update Date:2017-08-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OKR0061974163WD0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WD0400XNursing Service ProvidersRegistered NurseDiabetes Educator