Healthcare Provider Details

I. General information

NPI: 1396252003
Provider Name (Legal Business Name): LAUREN MICHELLE DONALDSON NNP-BC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/03/2018
Last Update Date: 09/19/2024
Certification Date: 09/19/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6151 S YALE AVE # LEVELB
TULSA OK
74136-1907
US

IV. Provider business mailing address

6600 S YALE AVE STE 1400
TULSA OK
74136-3331
US

V. Phone/Fax

Practice location:
  • Phone: 918-502-6097
  • Fax: 918-502-6046
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LN0000X
TaxonomyNeonatal Nurse Practitioner
License NumberR0103735
License Number StateOK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: