Healthcare Provider Details

I. General information

NPI: 1700292679
Provider Name (Legal Business Name): LAURA PEIFFER
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/10/2014
Last Update Date: 07/10/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2323 S HARVARD AVE
TULSA OK
74114-3301
US

IV. Provider business mailing address

2104 E 82ND CT # B
TULSA OK
74137-1509
US

V. Phone/Fax

Practice location:
  • Phone: 918-293-2150
  • Fax:
Mailing address:
  • Phone: 918-710-5107
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code247200000X
TaxonomyOther Technician
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: