Healthcare Provider Details

I. General information

NPI: 1992448500
Provider Name (Legal Business Name): AMANDA MAE LACROIX DO
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/20/2022
Last Update Date: 09/24/2024
Certification Date: 09/24/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

900 E MAIN ST
NORMAN OK
73071-5305
US

IV. Provider business mailing address

900 E MAIN ST
NORMAN OK
73071-5305
US

V. Phone/Fax

Practice location:
  • Phone: 405-573-6602
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number8188
License Number StateOK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: