Provider Demographics
NPI:1508199274
Name:LAQUERRE, HEATHER RENEE (MS, APRN, CNP)
Entity Type:Individual
Prefix:MS
First Name:HEATHER
Middle Name:RENEE
Last Name:LAQUERRE
Suffix:
Gender:F
Credentials:MS, APRN, CNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:102 N. BROADWAY
Mailing Address - Street 2:
Mailing Address - City:CARNEGIE
Mailing Address - State:OK
Mailing Address - Zip Code:73015
Mailing Address - Country:US
Mailing Address - Phone:580-654-1050
Mailing Address - Fax:
Practice Address - Street 1:102 N. BROADWAY
Practice Address - Street 2:
Practice Address - City:CARNEGIE
Practice Address - State:OK
Practice Address - Zip Code:73015
Practice Address - Country:US
Practice Address - Phone:580-654-1050
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-09-14
Last Update Date:2016-04-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK73556363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK73556OtherLICENSE NUMBER