Provider Demographics
NPI:1851411953
Name:BRUNNER, LAURA EILEEN
Entity Type:Individual
Prefix:MS
First Name:LAURA
Middle Name:EILEEN
Last Name:BRUNNER
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 1:1200 N PERKINS RD
Mailing Address - Street 2:APT T1
Mailing Address - City:STILLWATER
Mailing Address - State:OK
Mailing Address - Zip Code:74075-7104
Mailing Address - Country:US
Mailing Address - Phone:580-704-9101
Mailing Address - Fax:
Practice Address - Street 1:800 E 6TH AVE
Practice Address - Street 2:SUITE B
Practice Address - City:STILLWATER
Practice Address - State:OK
Practice Address - Zip Code:74075-3732
Practice Address - Country:US
Practice Address - Phone:405-372-1250
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-03-30
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK171M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator