Provider Demographics
NPI:1679877229
Name:DONALDSON, LAUREN NICOLE (PA-C, CAQ-PEDS)
Entity type:Individual
Prefix:MS
First Name:LAUREN
Middle Name:NICOLE
Last Name:DONALDSON
Suffix:
Gender:F
Credentials:PA-C, CAQ-PEDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:312 E RICH ST
Mailing Address - Street 2:
Mailing Address - City:NORMAN
Mailing Address - State:OK
Mailing Address - Zip Code:73069-7820
Mailing Address - Country:US
Mailing Address - Phone:580-747-5274
Mailing Address - Fax:
Practice Address - Street 1:2312 24TH AVE NW
Practice Address - Street 2:
Practice Address - City:NORMAN
Practice Address - State:OK
Practice Address - Zip Code:73069-6590
Practice Address - Country:US
Practice Address - Phone:405-652-0581
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-12-22
Last Update Date:2025-01-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK1989363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant