Provider Demographics
NPI:1447793138
Name:LASTER, JAMIE (RCS)
Entity Type:Individual
Prefix:
First Name:JAMIE
Middle Name:
Last Name:LASTER
Suffix:
Gender:F
Credentials:RCS
Other - Prefix:
Other - First Name:JAMIE
Other - Middle Name:L
Other - Last Name:THOUVENEL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:2413 SAINT ANDREWS CT
Mailing Address - Street 2:
Mailing Address - City:MUSKOGEE
Mailing Address - State:OK
Mailing Address - Zip Code:74403-1682
Mailing Address - Country:US
Mailing Address - Phone:918-910-4067
Mailing Address - Fax:918-910-4065
Practice Address - Street 1:2413 SAINT ANDREWS CT
Practice Address - Street 2:
Practice Address - City:MUSKOGEE
Practice Address - State:OK
Practice Address - Zip Code:74403-1682
Practice Address - Country:US
Practice Address - Phone:918-910-4067
Practice Address - Fax:918-910-4065
Is Sole Proprietor?:Yes
Enumeration Date:2016-11-29
Last Update Date:2016-11-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK000905862471S1302X
335V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes335V00000XSuppliersPortable X-ray and/or Other Portable Diagnostic Imaging Supplier
No2471S1302XTechnologists, Technicians & Other Technical Service ProvidersRadiologic TechnologistSonography