Provider Demographics
NPI:1447429972
Name:HANSEN, LORI ELDEAN (MD)
Entity type:Individual
Prefix:
First Name:LORI
Middle Name:ELDEAN
Last Name:HANSEN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13313 N. MERIDIAN
Mailing Address - Street 2:SUITE A-3
Mailing Address - City:OKLA CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73120
Mailing Address - Country:US
Mailing Address - Phone:405-753-9600
Mailing Address - Fax:405-753-9601
Practice Address - Street 1:13313 N. MERIDIAN
Practice Address - Street 2:SUITE A-3
Practice Address - City:OKLA CITY
Practice Address - State:OK
Practice Address - Zip Code:73120
Practice Address - Country:US
Practice Address - Phone:405-753-9600
Practice Address - Fax:405-753-9601
Is Sole Proprietor?:No
Enumeration Date:2008-02-28
Last Update Date:2011-04-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK13287208200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208200000XAllopathic & Osteopathic PhysiciansPlastic Surgery