Provider Demographics
NPI:1316142763
Name:LORENZEN, NICKOLATE
Entity type:Individual
Prefix:MRS
First Name:NICKOLATE
Middle Name:
Last Name:LORENZEN
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 1:1719 QUAIL CREEK DR
Mailing Address - Street 2:
Mailing Address - City:NORMAN
Mailing Address - State:OK
Mailing Address - Zip Code:73026-0943
Mailing Address - Country:US
Mailing Address - Phone:405-360-1838
Mailing Address - Fax:405-360-0818
Practice Address - Street 1:1719 QUAIL CREEK DR
Practice Address - Street 2:
Practice Address - City:NORMAN
Practice Address - State:OK
Practice Address - Zip Code:73026-0943
Practice Address - Country:US
Practice Address - Phone:405-360-1838
Practice Address - Fax:405-360-0818
Is Sole Proprietor?:Yes
Enumeration Date:2007-06-17
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK177F00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes177F00000XOther Service ProvidersLodging