Provider Demographics
NPI:1205699295
Name:SIMPSON, LAURELI MAKENZIE
Entity type:Individual
Prefix:MRS
First Name:LAURELI
Middle Name:MAKENZIE
Last Name:SIMPSON
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 1:1408 DUSTIN DR
Mailing Address - Street 2:
Mailing Address - City:EDMOND
Mailing Address - State:OK
Mailing Address - Zip Code:73003-4919
Mailing Address - Country:US
Mailing Address - Phone:405-919-8764
Mailing Address - Fax:
Practice Address - Street 1:1408 DUSTIN DR
Practice Address - Street 2:
Practice Address - City:EDMOND
Practice Address - State:OK
Practice Address - Zip Code:73003-4919
Practice Address - Country:US
Practice Address - Phone:405-919-8764
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-02-01
Last Update Date:2024-02-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program