Provider Demographics
NPI:1073596433
Name:RULE, LORI D (PA C)
Entity Type:Individual
Prefix:MRS
First Name:LORI
Middle Name:D
Last Name:RULE
Suffix:
Gender:F
Credentials:PA C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1516 S YORKTOWN PL
Mailing Address - Street 2:
Mailing Address - City:TULSA
Mailing Address - State:OK
Mailing Address - Zip Code:74104-4918
Mailing Address - Country:US
Mailing Address - Phone:918-712-8888
Mailing Address - Fax:918-712-8892
Practice Address - Street 1:1516 S YORKTOWN PL
Practice Address - Street 2:
Practice Address - City:TULSA
Practice Address - State:OK
Practice Address - Zip Code:74104-4918
Practice Address - Country:US
Practice Address - Phone:918-712-8888
Practice Address - Fax:918-712-8892
Is Sole Proprietor?:No
Enumeration Date:2005-11-21
Last Update Date:2019-02-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK658363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK100114540BMedicaid
S90754Medicare UPIN