Provider Demographics
NPI:1902882269
Name:STUTZMAN, TANA M (ARNP)
Entity Type:Individual
Prefix:
First Name:TANA
Middle Name:M
Last Name:STUTZMAN
Suffix:
Gender:F
Credentials:ARNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14 S VANN ST
Mailing Address - Street 2:
Mailing Address - City:PRYOR
Mailing Address - State:OK
Mailing Address - Zip Code:74361-3613
Mailing Address - Country:US
Mailing Address - Phone:918-825-4800
Mailing Address - Fax:918-825-4809
Practice Address - Street 1:14 S VANN ST
Practice Address - Street 2:
Practice Address - City:PRYOR
Practice Address - State:OK
Practice Address - Zip Code:74361-3613
Practice Address - Country:US
Practice Address - Phone:918-825-4800
Practice Address - Fax:918-825-4809
Is Sole Proprietor?:No
Enumeration Date:2005-12-19
Last Update Date:2008-01-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OKR0071260363LW0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LW0102XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerWomen's Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
OKP55041Medicare UPIN