Provider Demographics
NPI:1588924039
Name:MANSOUR, LAUREN (CNA, CHHA, LTC)
Entity type:Individual
Prefix:
First Name:LAUREN
Middle Name:
Last Name:MANSOUR
Suffix:
Gender:F
Credentials:CNA, CHHA, LTC
Other - Prefix:
Other - First Name:LAUREN
Other - Middle Name:
Other - Last Name:DOTY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:3517 E GILLETTE ST
Mailing Address - Street 2:
Mailing Address - City:BROKEN ARROW
Mailing Address - State:OK
Mailing Address - Zip Code:74014-8867
Mailing Address - Country:US
Mailing Address - Phone:191-860-6988
Mailing Address - Fax:
Practice Address - Street 1:3517 E GILLETTE ST
Practice Address - Street 2:
Practice Address - City:BROKEN ARROW
Practice Address - State:OK
Practice Address - Zip Code:74014-8867
Practice Address - Country:US
Practice Address - Phone:191-860-6988
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-05-17
Last Update Date:2012-05-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK37V243121202374U00000X
OK37V243111202376K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes376K00000XNursing Service Related ProvidersNurse's Aide
No374U00000XNursing Service Related ProvidersHome Health Aide