Provider Demographics
NPI:1760782882
Name:FROCK, LORI SUZANNE (RN)
Entity Type:Individual
Prefix:MRS
First Name:LORI
Middle Name:SUZANNE
Last Name:FROCK
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
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Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 506
Mailing Address - Street 2:
Mailing Address - City:ARDMORE
Mailing Address - State:OK
Mailing Address - Zip Code:73401
Mailing Address - Country:US
Mailing Address - Phone:580-465-9971
Mailing Address - Fax:580-276-3324
Practice Address - Street 1:66 OVERLAND RT
Practice Address - Street 2:
Practice Address - City:ARDMORE
Practice Address - State:OK
Practice Address - Zip Code:73401
Practice Address - Country:US
Practice Address - Phone:580-465-9971
Practice Address - Fax:580-276-3324
Is Sole Proprietor?:Yes
Enumeration Date:2010-10-22
Last Update Date:2011-09-06
Deactivation Date:
Deactivation Code:
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Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes323P00000XResidential Treatment FacilitiesPsychiatric Residential Treatment Facility