Healthcare Provider Details

I. General information

NPI: 1720565302
Provider Name (Legal Business Name): DANIEL TYLER LAAKMAN APRN FNP-C
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/25/2018
Last Update Date: 07/25/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1000 N LEE AVE
OKLAHOMA CITY OK
73102-1036
US

IV. Provider business mailing address

7420 NW 116TH PL
OKLAHOMA CITY OK
73162-1501
US

V. Phone/Fax

Practice location:
  • Phone: 405-272-7000
  • Fax: 405-270-7531
Mailing address:
  • Phone: 405-227-8031
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number102496
License Number StateOK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: