Basic Information
| Provider Information | |||||||||
| NPI: | 1104216662 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | HANNI | ||||||||
| FirstName: | MORGAN | ||||||||
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| Credential: | PA-C | ||||||||
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| Mailing Information | |||||||||
| Address1: | 6600 N OLIE AVE STE C | ||||||||
| Address2: | |||||||||
| City: | OKLAHOMA CITY | ||||||||
| State: | OK | ||||||||
| PostalCode: | 731167339 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4054195665 | ||||||||
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| Practice Location | |||||||||
| Address1: | 6600 N OLIE AVE STE C | ||||||||
| Address2: | |||||||||
| City: | OKLAHOMA CITY | ||||||||
| State: | OK | ||||||||
| PostalCode: | 731167339 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4054195665 | ||||||||
| FaxNumber: | 4054195429 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 02/04/2015 | ||||||||
| LastUpdateDate: | 07/14/2021 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 07/14/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363AS0400X | 2487 | OK | Y | Physician Assistants & Advanced Practice Nursing Providers | Physician Assistant | Surgical |
ID Information
| ID | Type | State | Issuer | Description | . | 01 | PA-C | OTHER |