Provider Demographics
NPI:1578973491
Name:GORNEK, LAURA SUZANNE
Entity Type:Individual
Prefix:
First Name:LAURA
Middle Name:SUZANNE
Last Name:GORNEK
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:LAURA
Other - Middle Name:SUZANNE
Other - Last Name:DESOUSA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:2325 S HARVARD AVE
Mailing Address - Street 2:
Mailing Address - City:TULSA
Mailing Address - State:OK
Mailing Address - Zip Code:74114-3300
Mailing Address - Country:US
Mailing Address - Phone:918-712-4301
Mailing Address - Fax:918-560-1399
Practice Address - Street 1:1308 S GARY PL
Practice Address - Street 2:
Practice Address - City:TULSA
Practice Address - State:OK
Practice Address - Zip Code:74104-4827
Practice Address - Country:US
Practice Address - Phone:918-740-2163
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-04-30
Last Update Date:2021-03-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator