Individual
MRS. LAURA RENEE BALLEW
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
1717 S UTICA AVE STE A, TULSA, OK 74104-5346
(918) 748-7559
Mailing address
2608 E 74TH ST, TULSA, OK 74136-5557
(918) 671-9454
Taxonomy
Speciality
Code
Description
License number
State
363L00000X
Nurse Practitioner
Primary
204093
OK
Other
Enumeration date
06/07/2021
Last updated
07/20/2023
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