Healthcare Provider Details

I. General information

NPI: 1720480890
Provider Name (Legal Business Name): MRS. VIRGINIA LAMPSON
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/20/2014
Last Update Date: 10/06/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1304 N DELAWARE ST
CHOUTEAU OK
74337-3644
US

IV. Provider business mailing address

1304 N DELAWARE ST
CHOUTEAU OK
74337-3644
US

V. Phone/Fax

Practice location:
  • Phone: 918-373-3011
  • Fax:
Mailing address:
  • Phone: 918-373-3011
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number
License Number StateOK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: