Provider Demographics
NPI:1649741232
Name:WILLIAMS, LORA JANE
Entity Type:Individual
Prefix:
First Name:LORA
Middle Name:JANE
Last Name:WILLIAMS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14330 SE 29TH ST
Mailing Address - Street 2:
Mailing Address - City:CHOCTAW
Mailing Address - State:OK
Mailing Address - Zip Code:73020-6584
Mailing Address - Country:US
Mailing Address - Phone:405-365-7716
Mailing Address - Fax:405-702-9711
Practice Address - Street 1:3101 TINKER DIAGONAL
Practice Address - Street 2:
Practice Address - City:DEL CITY
Practice Address - State:OK
Practice Address - Zip Code:73115-1019
Practice Address - Country:US
Practice Address - Phone:405-737-9039
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-12-08
Last Update Date:2018-12-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes175T00000XOther Service ProvidersPeer Specialist