Provider Demographics
NPI:1093154239
Name:EDWARDS, LORI SUZANNE (APRN-CNM)
Entity Type:Individual
Prefix:
First Name:LORI
Middle Name:SUZANNE
Last Name:EDWARDS
Suffix:
Gender:F
Credentials:APRN-CNM
Other - Prefix:
Other - First Name:LORI
Other - Middle Name:SUZANNE
Other - Last Name:HIGHTOWER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:2401 SOUTHWEST BLVD
Mailing Address - Street 2:
Mailing Address - City:TULSA
Mailing Address - State:OK
Mailing Address - Zip Code:74107-2726
Mailing Address - Country:US
Mailing Address - Phone:918-561-5701
Mailing Address - Fax:918-561-1173
Practice Address - Street 1:3345 S HARVARD AVE STE 201
Practice Address - Street 2:
Practice Address - City:TULSA
Practice Address - State:OK
Practice Address - Zip Code:74135-1809
Practice Address - Country:US
Practice Address - Phone:918-271-5966
Practice Address - Fax:918-271-5976
Is Sole Proprietor?:No
Enumeration Date:2013-06-20
Last Update Date:2019-07-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK76836367A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367A00000XPhysician Assistants & Advanced Practice Nursing ProvidersAdvanced Practice Midwife