| Doctor Name: | LAURA ANNE WALGREN |
| NPI Number: | 1235108168 |
| Entity Type Code: | Individual (1) |
| Gender: | F |
| Credentials: | PA-C |
| License Number: | PAD T 1735 |
| Business Practice Address: | 1000 S Byrd St Tishomingo, OK - 734603265 |
| Business Phone Number: | 5803712327 |
| Business Fax Number: | 5803712127 |
| Mailing Address: | 530 N Monte Vista St, Suite A ADA |
| State: | OK |
| Postal Code: | 748204675 |
| Phone Number: | 5804367101 |
| Fax Number: | 5804364447 |
| NPI Enumeration Date: | 03/14/2006 |
| NPI Last Update Date: | 03/19/2015 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 363AM0700X |
| License Number: | PAD T 1735 |
| Healthcare Provider Taxonomy: (Secondary) | N |
| State: | AK |
| Taxonomy Type: | Physician Assistants & Advanced Practice Nursing Providers |
| Taxonomy Classification: | Physician Assistant |
| Taxonomy Specialization: | Medical |
| Taxonomy Definition: | |