Healthcare Provider Details

I. General information

NPI: 1598357857
Provider Name (Legal Business Name): LINDSEY V LANCASTER
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: LINDSEY V BOREN

II. Dates (important events)

Enumeration Date: 02/08/2021
Last Update Date: 08/06/2021
Certification Date: 08/06/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3261 24TH AVE NW STE 101
NORMAN OK
73069-6666
US

IV. Provider business mailing address

3261 24TH AVE NW STE 101
NORMAN OK
73069-6666
US

V. Phone/Fax

Practice location:
  • Phone: 405-364-6432
  • Fax:
Mailing address:
  • Phone: 405-364-6432
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License NumberRN0090016
License Number StateOK
# 2
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number204257
License Number StateOK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: