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NPI Code Detail

MEDICARE: LARA JEAN EASTERWOOD ARNP-CNP

MEDICARE: LARA JEAN EASTERWOOD ARNP-CNP
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
1363LA2200XAdult Health Nurse Practitioner76862OK

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1790974103
Entity Type Code : Individual
Provider Name (Legal Business Name) : LARA JEAN EASTERWOOD ARNP-CNP
Provider Business Mailing Address
First Line : PO BOX 268938
Second Line :
City : OKLAHOMA CITY
State : OK
Zip : 73126-8938
Country : US
Telephone Number : 405-752-9600
Fax Number : 405-752-9650
Provider Business Practice Location Address
First Line : 5101 W MEMORIAL RD
Second Line :
City : OKLAHOMA CITY
State : OK
Zip : 73142-2018
Country : US
Telephone Number : 405-752-9600
Fax Number : 405-752-9650
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 10/22/2007
Last Update Date : 08/20/2014

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