Provider Demographics
NPI:1609115484
Name:VLANICH, CHANDA RAYE (APRN-CRNA)
Entity Type:Individual
Prefix:
First Name:CHANDA
Middle Name:RAYE
Last Name:VLANICH
Suffix:
Gender:F
Credentials:APRN-CRNA
Other - Prefix:
Other - First Name:CHANDA
Other - Middle Name:
Other - Last Name:POPLIN
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:1923 S UTICA AVE
Mailing Address - Street 2:BOX 217
Mailing Address - City:TULSA
Mailing Address - State:OK
Mailing Address - Zip Code:74104-6520
Mailing Address - Country:US
Mailing Address - Phone:918-744-3664
Mailing Address - Fax:918-748-7688
Practice Address - Street 1:1923 S UTICA AVE
Practice Address - Street 2:BOX 217
Practice Address - City:TULSA
Practice Address - State:OK
Practice Address - Zip Code:74104-6520
Practice Address - Country:US
Practice Address - Phone:918-744-3664
Practice Address - Fax:918-748-7688
Is Sole Proprietor?:No
Enumeration Date:2013-02-13
Last Update Date:2014-02-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK76462367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered