Healthcare Provider Details

I. General information

NPI: 1093154239
Provider Name (Legal Business Name): LORI SUZANNE EDWARDS APRN-CNM
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: LORI SUZANNE HIGHTOWER

II. Dates (important events)

Enumeration Date: 06/20/2013
Last Update Date: 07/12/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3345 S HARVARD AVE STE 201
TULSA OK
74135-1809
US

IV. Provider business mailing address

2401 SOUTHWEST BLVD
TULSA OK
74107-2726
US

V. Phone/Fax

Practice location:
  • Phone: 918-271-5966
  • Fax: 918-271-5976
Mailing address:
  • Phone: 918-561-5701
  • Fax: 918-561-1173

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367A00000X
TaxonomyAdvanced Practice Midwife
License Number76836
License Number StateOK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: