Individual
MANJU ANI THANKACHAN
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
CRNA
Contact information
Practice address
3401 W GORE BLVD, LAWTON, OK 73505-6332
(580) 355-8620
Mailing address
PO BOX 2309, LAWTON, OK 73502-2309
(580) 355-8620
Taxonomy
Speciality
Code
Description
License number
State
367500000X
Certified Registered Nurse Anesthetist
110237
TN
367500000X
Certified Registered Nurse Anesthetist
Primary
81949
OK
Other
Enumeration date
08/20/2016
Last updated
04/27/2017
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