Provider Demographics
NPI:1770729907
Name:VIJAYAN, MANIMEHALAI (RN ADVANCE PRACTICE)
Entity type:Individual
Prefix:MRS
First Name:MANIMEHALAI
Middle Name:
Last Name:VIJAYAN
Suffix:
Gender:F
Credentials:RN ADVANCE PRACTICE
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Mailing Address - Street 1:940 NE 13TH ST STE 3000
Mailing Address - Street 2:
Mailing Address - City:OKLAHOMA CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73104-5008
Mailing Address - Country:US
Mailing Address - Phone:405-271-7498
Mailing Address - Fax:405-271-4329
Practice Address - Street 1:940 N.E. 13TH STREET
Practice Address - Street 2:SUITE 3000
Practice Address - City:OKLAHOMA CITY
Practice Address - State:OK
Practice Address - Zip Code:73104-5008
Practice Address - Country:US
Practice Address - Phone:405-271-7498
Practice Address - Fax:405-271-4328
Is Sole Proprietor?:No
Enumeration Date:2008-12-17
Last Update Date:2018-10-04
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
OK64359364S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes364S00000XPhysician Assistants & Advanced Practice Nursing ProvidersClinical Nurse Specialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK200281460AMedicaid
OKOKA100467Medicare PIN