Provider Demographics
NPI:1649548710
Name:MANNING, PAMELA JO (RN)
Entity type:Individual
Prefix:
First Name:PAMELA
Middle Name:JO
Last Name:MANNING
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:1808 COUNCIL BLUFF DR
Mailing Address - Street 2:
Mailing Address - City:EDMOND
Mailing Address - State:OK
Mailing Address - Zip Code:73013-6867
Mailing Address - Country:US
Mailing Address - Phone:405-348-2127
Mailing Address - Fax:405-242-5071
Practice Address - Street 1:2525 NW EXPRESSWAY
Practice Address - Street 2:SUITE 624 A
Practice Address - City:OKLAHOMA CITY
Practice Address - State:OK
Practice Address - Zip Code:73112-7227
Practice Address - Country:US
Practice Address - Phone:405-242-5070
Practice Address - Fax:405-242-5071
Is Sole Proprietor?:Yes
Enumeration Date:2011-12-05
Last Update Date:2011-12-05
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
OKR0030695163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse