Provider Demographics
NPI:1144997180
Name:WHITE, LAURETTA (NURSE PRACTITIONER)
Entity type:Individual
Prefix:
First Name:LAURETTA
Middle Name:
Last Name:WHITE
Suffix:
Gender:F
Credentials:NURSE PRACTITIONER
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1267 N 4160 RD
Mailing Address - Street 2:
Mailing Address - City:HUGO
Mailing Address - State:OK
Mailing Address - Zip Code:74743-8518
Mailing Address - Country:US
Mailing Address - Phone:405-838-2911
Mailing Address - Fax:
Practice Address - Street 1:1267 N 4160 RD
Practice Address - Street 2:
Practice Address - City:HUGO
Practice Address - State:OK
Practice Address - Zip Code:74743-8518
Practice Address - Country:US
Practice Address - Phone:405-838-2911
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-08-26
Last Update Date:2021-08-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK205111363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner