Provider Demographics
NPI:1487165619
Name:LAWRENCE, BRIANA
Entity type:Individual
Prefix:
First Name:BRIANA
Middle Name:
Last Name:LAWRENCE
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 1:3200 WRIGHT AVE
Mailing Address - Street 2:
Mailing Address - City:SPENCER
Mailing Address - State:OK
Mailing Address - Zip Code:73084-5807
Mailing Address - Country:US
Mailing Address - Phone:405-600-8709
Mailing Address - Fax:
Practice Address - Street 1:2000 NE 23RD ST
Practice Address - Street 2:
Practice Address - City:OKLAHOMA CITY
Practice Address - State:OK
Practice Address - Zip Code:73111-3402
Practice Address - Country:US
Practice Address - Phone:405-600-8709
Practice Address - Fax:405-600-8709
Is Sole Proprietor?:Yes
Enumeration Date:2017-10-16
Last Update Date:2018-12-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK37T045020617374U00000X, 364SL0600X
171M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator
No374U00000XNursing Service Related ProvidersHome Health Aide
No364SL0600XPhysician Assistants & Advanced Practice Nursing ProvidersClinical Nurse SpecialistLong-Term Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK82-2471365Medicaid