Provider Demographics
NPI:1356813679
Name:MORAN, LONNIE
Entity Type:Individual
Prefix:
First Name:LONNIE
Middle Name:
Last Name:MORAN
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2323 S SHERIDAN RD
Mailing Address - Street 2:
Mailing Address - City:TULSA
Mailing Address - State:OK
Mailing Address - Zip Code:74129-1043
Mailing Address - Country:US
Mailing Address - Phone:918-838-1000
Mailing Address - Fax:918-836-0788
Practice Address - Street 1:2323 S SHERIDAN RD
Practice Address - Street 2:
Practice Address - City:TULSA
Practice Address - State:OK
Practice Address - Zip Code:74129-1043
Practice Address - Country:US
Practice Address - Phone:918-838-1000
Practice Address - Fax:918-836-0788
Is Sole Proprietor?:No
Enumeration Date:2018-12-27
Last Update Date:2019-01-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK001223237700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes237700000XSpeech, Language and Hearing Service ProvidersHearing Instrument Specialist