Provider Demographics
NPI:1780937342
Name:CHRISTOPHER, LADAWN ANN (COTA)
Entity type:Individual
Prefix:MRS
First Name:LADAWN
Middle Name:ANN
Last Name:CHRISTOPHER
Suffix:
Gender:F
Credentials:COTA
Other - Prefix:MISS
Other - First Name:LADAWN
Other - Middle Name:ANN
Other - Last Name:MAY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:COTA
Mailing Address - Street 1:2408 VILLA LANTE CIR
Mailing Address - Street 2:
Mailing Address - City:OKLAHOMA CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73170-3229
Mailing Address - Country:US
Mailing Address - Phone:405-703-0913
Mailing Address - Fax:
Practice Address - Street 1:2408 VILLA LANTE CIR
Practice Address - Street 2:
Practice Address - City:OKLAHOMA CITY
Practice Address - State:OK
Practice Address - Zip Code:73170-3229
Practice Address - Country:US
Practice Address - Phone:405-703-0913
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-10-19
Last Update Date:2012-10-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK154172V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172V00000XOther Service ProvidersCommunity Health Worker