Provider Demographics
NPI:1104951839
Name:HEINRICH, NATALIE DENISE (PA-C)
Entity type:Individual
Prefix:
First Name:NATALIE
Middle Name:DENISE
Last Name:HEINRICH
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:NATALIE
Other - Middle Name:DENISE
Other - Last Name:ROGERS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PA-C
Mailing Address - Street 1:1923 S UTICA AVE
Mailing Address - Street 2:CHAPMAN TOWER, LL
Mailing Address - City:TULSA
Mailing Address - State:OK
Mailing Address - Zip Code:74104-6520
Mailing Address - Country:US
Mailing Address - Phone:918-744-2071
Mailing Address - Fax:918-744-3064
Practice Address - Street 1:1923 S UTICA AVE
Practice Address - Street 2:CHAPMAN TOWER, LL
Practice Address - City:TULSA
Practice Address - State:OK
Practice Address - Zip Code:74104-6520
Practice Address - Country:US
Practice Address - Phone:918-744-2071
Practice Address - Fax:918-744-3064
Is Sole Proprietor?:No
Enumeration Date:2007-02-22
Last Update Date:2013-09-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK1600363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK200119830AMedicaid