Provider Demographics
NPI:1780140293
Name:RUNQUIST, LAUREN
Entity type:Individual
Prefix:
First Name:LAUREN
Middle Name:
Last Name:RUNQUIST
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 1:121 NORTH AVE
Mailing Address - Street 2:
Mailing Address - City:TULSA
Mailing Address - State:OK
Mailing Address - Zip Code:74101-2398
Mailing Address - Country:US
Mailing Address - Phone:782-098-9876
Mailing Address - Fax:
Practice Address - Street 1:121 NORTH AVE
Practice Address - Street 2:
Practice Address - City:TULSA
Practice Address - State:OH
Practice Address - Zip Code:74101
Practice Address - Country:US
Practice Address - Phone:763-485-1232
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-02-20
Last Update Date:2020-05-01
Deactivation Date:2019-09-29
Deactivation Code:
Reactivation Date:2020-05-01
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer