Individual
LANNY SETIAWAN
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
2448 E 81ST STREET, SUITE 4824, TULSA, OK 74137-4320
(918) 392-7875
Mailing address
6212 E 72ND STREET, APT 829, TULSA, OK 74136-6945
(918) 859-4035
Taxonomy
Speciality
Code
Description
License number
State
225400000X
Rehabilitation Practitioner
Primary
—
—
Other
Enumeration date
12/02/2011
Last updated
12/02/2011
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