Provider Demographics
NPI:1033764113
Name:BOX, LAUREN DIANE
Entity Type:Individual
Prefix:
First Name:LAUREN
Middle Name:DIANE
Last Name:BOX
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:362 FELKER RD
Mailing Address - Street 2:
Mailing Address - City:VALLIANT
Mailing Address - State:OK
Mailing Address - Zip Code:74764-5291
Mailing Address - Country:US
Mailing Address - Phone:580-212-9374
Mailing Address - Fax:
Practice Address - Street 1:300 N DALTON ST
Practice Address - Street 2:
Practice Address - City:VALLIANT
Practice Address - State:OK
Practice Address - Zip Code:74764-8029
Practice Address - Country:US
Practice Address - Phone:580-933-7031
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-08-06
Last Update Date:2019-08-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator