Provider Demographics
NPI:1275873408
Name:LASTER, TREMESHIA LADON
Entity Type:Individual
Prefix:MRS
First Name:TREMESHIA
Middle Name:LADON
Last Name:LASTER
Suffix:
Gender:F
Credentials:
Other - Prefix:MS
Other - First Name:TREMESHIA
Other - Middle Name:LADON
Other - Last Name:GULLEY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:2520 NW 39TH TER
Mailing Address - Street 2:SUITE 100
Mailing Address - City:OKLAHOMA CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73112-3730
Mailing Address - Country:US
Mailing Address - Phone:405-816-5722
Mailing Address - Fax:
Practice Address - Street 1:2520 NW 39TH TER
Practice Address - Street 2:SUITE 100
Practice Address - City:OKLAHOMA CITY
Practice Address - State:OK
Practice Address - Zip Code:73112-3730
Practice Address - Country:US
Practice Address - Phone:405-816-5722
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-02-25
Last Update Date:2013-02-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program