Provider Demographics
NPI:1013778356
Name:LACMAGO, JOSYLINE
Entity Type:Individual
Prefix:
First Name:JOSYLINE
Middle Name:
Last Name:LACMAGO
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 1:9100 ANAUM LN
Mailing Address - Street 2:
Mailing Address - City:YUKON
Mailing Address - State:OK
Mailing Address - Zip Code:73099-3885
Mailing Address - Country:US
Mailing Address - Phone:405-857-5145
Mailing Address - Fax:
Practice Address - Street 1:9100 ANAUM LN
Practice Address - Street 2:
Practice Address - City:YUKON
Practice Address - State:OK
Practice Address - Zip Code:73099-3885
Practice Address - Country:US
Practice Address - Phone:405-857-5145
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-01-23
Last Update Date:2024-01-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK200934163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse