MEDICARE: MRS. INGRID LAUB BLOCK RN, MS, CNS

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	163WX0200X	Oncology Registered Nurse	R0059925	OK

General Provider Information

NPI Number	:	1447487764
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. INGRID LAUB BLOCK RN, MS, CNS

Provider Business Mailing Address
First Line	:	920 SL YOUNG
Second Line	:	WP 2410
City	:	OKLAHOMA CITY
State	:	OK
Zip	:	73104-5033
Country	:	US
Telephone Number	:	405-271-8777
Fax Number	:	405-271-6275

Provider Business Practice Location Address
First Line	:	920 SL YOUNG
Second Line	:	WP 2410
City	:	OKLAHOMA CITY
State	:	OK
Zip	:	73104-5033
Country	:	US
Telephone Number	:	405-271-8777
Fax Number	:	405-271-6275

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/12/2009
Last Update Date	:	06/12/2009

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