Provider Demographics
NPI:1861036055
Name:NATERAS, CARMEN GABRIELA (APRN-CNP)
Entity type:Individual
Prefix:
First Name:CARMEN
Middle Name:GABRIELA
Last Name:NATERAS
Suffix:
Gender:F
Credentials:APRN-CNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6324 E 56TH PL
Mailing Address - Street 2:
Mailing Address - City:TULSA
Mailing Address - State:OK
Mailing Address - Zip Code:74135-8111
Mailing Address - Country:US
Mailing Address - Phone:918-697-9352
Mailing Address - Fax:918-512-4900
Practice Address - Street 1:5970 E 31ST ST STE I
Practice Address - Street 2:
Practice Address - City:TULSA
Practice Address - State:OK
Practice Address - Zip Code:74135-5112
Practice Address - Country:US
Practice Address - Phone:918-964-2596
Practice Address - Fax:918-512-4900
Is Sole Proprietor?:Yes
Enumeration Date:2019-10-31
Last Update Date:2019-10-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK123065363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK123065OtherAPRN-CNP