Basic Information
| Provider Information | |||||||||
| NPI: | 1568170785 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | LAURENT | ||||||||
| FirstName: | SYDNEY | ||||||||
| MiddleName: | ANN | ||||||||
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| Mailing Information | |||||||||
| Address1: | 4708 DEL AIRE DR | ||||||||
| Address2: | |||||||||
| City: | DEL CITY | ||||||||
| State: | OK | ||||||||
| PostalCode: | 731154304 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8069307725 | ||||||||
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| Practice Location | |||||||||
| Address1: | 1102 W MACARTHUR ST | ||||||||
| Address2: | |||||||||
| City: | SHAWNEE | ||||||||
| State: | OK | ||||||||
| PostalCode: | 748041743 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4052732270 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 11/07/2022 | ||||||||
| LastUpdateDate: | 11/07/2022 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 11/04/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363A00000X | 4889 | OK | Y | Physician Assistants & Advanced Practice Nursing Providers | Physician Assistant |
No ID Information.