Individual
DIADRA LORSEH
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA-C
Contact information
Practice address
2100 W IOWA AVE, CHICKASHA, OK 73018-2736
(405) 224-2100
(405) 779-2166
Mailing address
2100 W IOWA AVE, CHICKASHA, OK 73018-2736
(405) 224-2100
(405) 779-2166
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
2040
OK
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
200411660A
—
OK
Enumeration date
04/09/2010
Last updated
11/30/2016
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