Provider Demographics
NPI:1386857688
Name:CUDD, LAURA ANNETTE (DPH)
Entity Type:Individual
Prefix:MS
First Name:LAURA
Middle Name:ANNETTE
Last Name:CUDD
Suffix:
Gender:F
Credentials:DPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8709 NW 157TH PL
Mailing Address - Street 2:
Mailing Address - City:EDMOND
Mailing Address - State:OK
Mailing Address - Zip Code:73013-2109
Mailing Address - Country:US
Mailing Address - Phone:405-570-9496
Mailing Address - Fax:
Practice Address - Street 1:8709 NW 157TH PL
Practice Address - Street 2:
Practice Address - City:EDMOND
Practice Address - State:OK
Practice Address - Zip Code:73013-2109
Practice Address - Country:US
Practice Address - Phone:405-570-9496
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-05-07
Last Update Date:2021-11-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK11258183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist