Provider Demographics
NPI:1013359298
Name:MAXWELL, LORI ANN (APRN)
Entity Type:Individual
Prefix:
First Name:LORI
Middle Name:ANN
Last Name:MAXWELL
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4502 E 41ST ST RM 1C76
Mailing Address - Street 2:
Mailing Address - City:TULSA
Mailing Address - State:OK
Mailing Address - Zip Code:74135-2536
Mailing Address - Country:US
Mailing Address - Phone:918-660-3102
Mailing Address - Fax:918-660-3101
Practice Address - Street 1:4502 E 41ST ST RM 1C76
Practice Address - Street 2:
Practice Address - City:TULSA
Practice Address - State:OK
Practice Address - Zip Code:74135-2536
Practice Address - Country:US
Practice Address - Phone:918-660-3102
Practice Address - Fax:918-660-3101
Is Sole Proprietor?:No
Enumeration Date:2013-07-29
Last Update Date:2023-02-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK79283363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK200502080AMedicaid
OK200502080AMedicaid