Individual
LORI LYN ENLOW
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
NURSE PRACTITIONER
Contact information
Practice address
1203 E ROSS BYP, SUITE A, TAHLEQUAH, OK 74464
(918) 453-1234
(918) 453-9107
Mailing address
1203 E ROSS BYP STE A, TAHLEQUAH, OK 74464-4158
(918) 453-1234
(918) 453-9107
Taxonomy
Speciality
Code
Description
License number
State
363L00000X
Nurse Practitioner
Primary
R0067005
OK
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
200000030A
MEDICAID GROUP NUMBER
OK
05
—
200073760A
—
OK
01
—
400522239
MEDICARE GROUP PTAN
OK
01
—
DA5295
RAILROAD MEDICARE GROUP NUMBER
OK
01
—
P00399872
RAILROAD MEDICARE PIN NUMBER
OK
Enumeration date
10/14/2005
Last updated
06/04/2019
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