Provider Demographics
NPI:1326804584
Name:PONTIFLET, LAURETTA JEM
Entity Type:Individual
Prefix:MRS
First Name:LAURETTA
Middle Name:JEM
Last Name:PONTIFLET
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:LAURETTA
Other - Middle Name:JEM
Other - Last Name:FRANCIS
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:RN
Mailing Address - Street 1:7606 N 127TH EAST AVE
Mailing Address - Street 2:
Mailing Address - City:OWASSO
Mailing Address - State:OK
Mailing Address - Zip Code:74055-7943
Mailing Address - Country:US
Mailing Address - Phone:770-875-0139
Mailing Address - Fax:
Practice Address - Street 1:7606 N 127TH EAST AVE
Practice Address - Street 2:
Practice Address - City:OWASSO
Practice Address - State:OK
Practice Address - Zip Code:74055-7943
Practice Address - Country:US
Practice Address - Phone:770-875-0139
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-02-26
Last Update Date:2024-02-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator