Provider Demographics
NPI:1215540885
Name:BURKHALTER, LAUREN ELIZABETH (STUDENT BA)
Entity Type:Individual
Prefix:MISS
First Name:LAUREN
Middle Name:ELIZABETH
Last Name:BURKHALTER
Suffix:
Gender:F
Credentials:STUDENT BA
Other - Prefix:MISS
Other - First Name:LAUREN
Other - Middle Name:ELIZABETH
Other - Last Name:BURKHALTER
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:STUDENT BA
Mailing Address - Street 1:106 CASTRO ST UNIT 2
Mailing Address - Street 2:
Mailing Address - City:NORMAN
Mailing Address - State:OK
Mailing Address - Zip Code:73069-5962
Mailing Address - Country:US
Mailing Address - Phone:580-380-5752
Mailing Address - Fax:
Practice Address - Street 1:106 CASTRO ST UNIT 2
Practice Address - Street 2:
Practice Address - City:NORMAN
Practice Address - State:OK
Practice Address - Zip Code:73069-5962
Practice Address - Country:US
Practice Address - Phone:580-380-5752
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-08-24
Last Update Date:2020-08-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program