Provider Demographics
NPI:1649612847
Name:BLOOMFIELD, LAURA THORNTON (APRN)
Entity type:Individual
Prefix:
First Name:LAURA
Middle Name:THORNTON
Last Name:BLOOMFIELD
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 1:1245 S UTICA AVE
Mailing Address - Street 2:2ND FLOOR WEST
Mailing Address - City:TULSA
Mailing Address - State:OK
Mailing Address - Zip Code:74104-4214
Mailing Address - Country:US
Mailing Address - Phone:918-382-2551
Mailing Address - Fax:918-382-2561
Practice Address - Street 1:1245 S UTICA AVE
Practice Address - Street 2:2ND FLOOR WEST
Practice Address - City:TULSA
Practice Address - State:OK
Practice Address - Zip Code:74104-4214
Practice Address - Country:US
Practice Address - Phone:918-382-2551
Practice Address - Fax:918-382-2561
Is Sole Proprietor?:No
Enumeration Date:2013-07-29
Last Update Date:2015-08-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK41509363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK200501720AMedicaid
OK313954YLV0Medicare PIN