Provider Demographics
NPI:1528622677
Name:AZUERO, NADIA CAROLINA (MD)
Entity type:Individual
Prefix:
First Name:NADIA
Middle Name:CAROLINA
Last Name:AZUERO
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:NADIA
Other - Middle Name:CAROLINA
Other - Last Name:AZUERO
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MD
Mailing Address - Street 1:100 N 30TH ST STE 7
Mailing Address - Street 2:
Mailing Address - City:CLINTON
Mailing Address - State:OK
Mailing Address - Zip Code:73601-3117
Mailing Address - Country:US
Mailing Address - Phone:404-944-0685
Mailing Address - Fax:580-547-5035
Practice Address - Street 1:100 N 30TH ST STE 7
Practice Address - Street 2:
Practice Address - City:CLINTON
Practice Address - State:OK
Practice Address - Zip Code:73601-3117
Practice Address - Country:US
Practice Address - Phone:404-944-0685
Practice Address - Fax:580-547-5035
Is Sole Proprietor?:Yes
Enumeration Date:2019-04-24
Last Update Date:2025-06-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY55651207Q00000X
OK41545207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY7100722380Medicaid