Provider Demographics
NPI:1235550658
Name:STEELE, LAVETRICE (PA)
Entity Type:Individual
Prefix:
First Name:LAVETRICE
Middle Name:
Last Name:STEELE
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:LAVETRICE
Other - Middle Name:
Other - Last Name:STEELE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PA
Mailing Address - Street 1:996 SKYLINE BLVD
Mailing Address - Street 2:
Mailing Address - City:EDMOND
Mailing Address - State:OK
Mailing Address - Zip Code:73025-2438
Mailing Address - Country:US
Mailing Address - Phone:918-839-2803
Mailing Address - Fax:
Practice Address - Street 1:1221 N KELLY AVE
Practice Address - Street 2:
Practice Address - City:EDMOND
Practice Address - State:OK
Practice Address - Zip Code:73003-4865
Practice Address - Country:US
Practice Address - Phone:918-839-2803
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-01-02
Last Update Date:2016-10-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant