Individual
JILL ANN TANYAN
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
BS
Contact information
Practice address
512 BURBANK ST, MUSKOGEE, OK 74403-8303
(918) 990-1720
Mailing address
512 BURBANK ST, MUSKOGEE, OK 74403-8303
(918) 990-1720
Taxonomy
Speciality
Code
Description
License number
State
171M00000X
Case Manager/Care Coordinator
Primary
—
OK
Other
Enumeration date
03/09/2020
Last updated
03/09/2020
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