Provider Demographics
NPI:1285185017
Name:LAURENT, TAWANA
Entity Type:Individual
Prefix:MS
First Name:TAWANA
Middle Name:
Last Name:LAURENT
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 1:1509 SAND SPRINGS TRL
Mailing Address - Street 2:
Mailing Address - City:EDMOND
Mailing Address - State:OK
Mailing Address - Zip Code:73013-2608
Mailing Address - Country:US
Mailing Address - Phone:405-408-4295
Mailing Address - Fax:
Practice Address - Street 1:1509 SAND SPRINGS TRL
Practice Address - Street 2:
Practice Address - City:EDMOND
Practice Address - State:OK
Practice Address - Zip Code:73013-2608
Practice Address - Country:US
Practice Address - Phone:405-408-4295
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-10-17
Last Update Date:2016-10-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator