Provider Demographics
NPI:1285397604
Name:SCHWANKE, LAURA
Entity type:Individual
Prefix:
First Name:LAURA
Middle Name:
Last Name:SCHWANKE
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 1:12656 KATHERINE BRENNAND RD
Mailing Address - Street 2:
Mailing Address - City:EL PASO
Mailing Address - State:TX
Mailing Address - Zip Code:79928-5892
Mailing Address - Country:US
Mailing Address - Phone:559-317-5866
Mailing Address - Fax:
Practice Address - Street 1:420 SW 10TH ST
Practice Address - Street 2:
Practice Address - City:OKLAHOMA CITY
Practice Address - State:OK
Practice Address - Zip Code:73109-5610
Practice Address - Country:US
Practice Address - Phone:405-236-0709
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-10-21
Last Update Date:2021-10-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator