Provider Demographics
NPI:1831216852
Name:UMDENSTOCK, LOIS ANN (OTR)
Entity type:Individual
Prefix:MRS
First Name:LOIS
Middle Name:ANN
Last Name:UMDENSTOCK
Suffix:
Gender:F
Credentials:OTR
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6136 S FULTON AVE
Mailing Address - Street 2:
Mailing Address - City:TULSA
Mailing Address - State:OK
Mailing Address - Zip Code:74136-2007
Mailing Address - Country:US
Mailing Address - Phone:918-493-1618
Mailing Address - Fax:
Practice Address - Street 1:6136 S FULTON AVE
Practice Address - Street 2:
Practice Address - City:TULSA
Practice Address - State:OK
Practice Address - Zip Code:74136-2007
Practice Address - Country:US
Practice Address - Phone:918-493-1618
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-23
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OKOT361171000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171000000XOther Service ProvidersMilitary Health Care Provider