Provider Demographics
NPI:1255704821
Name:LUMRY, LISA (RN)
Entity type:Individual
Prefix:MRS
First Name:LISA
Middle Name:
Last Name:LUMRY
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3400 DESKIN DR
Mailing Address - Street 2:
Mailing Address - City:NORMAN
Mailing Address - State:OK
Mailing Address - Zip Code:73069-8295
Mailing Address - Country:US
Mailing Address - Phone:405-701-8530
Mailing Address - Fax:405-701-8531
Practice Address - Street 1:3400 DESKIN DR
Practice Address - Street 2:
Practice Address - City:NORMAN
Practice Address - State:OK
Practice Address - Zip Code:73069-8295
Practice Address - Country:US
Practice Address - Phone:405-701-8530
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-11-04
Last Update Date:2015-12-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK94440163WP0807X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WP0807XNursing Service ProvidersRegistered NursePsychiatric/Mental Health, Child & Adolescent