Provider Demographics
NPI:1831939214
Name:WHITLATCH, LAURA ROSE (LPN)
Entity type:Individual
Prefix:
First Name:LAURA
Middle Name:ROSE
Last Name:WHITLATCH
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:100 W MAIN ST STE 400
Mailing Address - Street 2:
Mailing Address - City:PAWHUSKA
Mailing Address - State:OK
Mailing Address - Zip Code:74056-4151
Mailing Address - Country:US
Mailing Address - Phone:918-397-3617
Mailing Address - Fax:
Practice Address - Street 1:100 W MAIN ST STE 400
Practice Address - Street 2:
Practice Address - City:PAWHUSKA
Practice Address - State:OK
Practice Address - Zip Code:74056-4151
Practice Address - Country:US
Practice Address - Phone:539-212-2499
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-05-31
Last Update Date:2024-05-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK205240164W00000X
171M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator
No164W00000XNursing Service ProvidersLicensed Practical Nurse