Individual
LACI NICOLE AST
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
6128 E 38TH ST, TULSA, OK 74135-5832
(844) 458-2100
Mailing address
6128 E 38TH ST, TULSA, OK 74135-5832
(844) 458-2100
Taxonomy
Speciality
Code
Description
License number
State
164W00000X
Licensed Practical Nurse
Primary
23-55083-122
KS
Other
Enumeration date
08/04/2025
Last updated
08/04/2025
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