Provider Demographics
NPI:1114262474
Name:SCARDINO, NATALIE MAGUIRE (PA,C)
Entity Type:Individual
Prefix:
First Name:NATALIE
Middle Name:MAGUIRE
Last Name:SCARDINO
Suffix:
Gender:F
Credentials:PA,C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6600 S YALE AVE
Mailing Address - Street 2:STE 1400
Mailing Address - City:TULSA
Mailing Address - State:OK
Mailing Address - Zip Code:74136-3331
Mailing Address - Country:US
Mailing Address - Phone:918-488-6687
Mailing Address - Fax:
Practice Address - Street 1:2950 S ELM PL STE 152
Practice Address - Street 2:
Practice Address - City:BROKEN ARROW
Practice Address - State:OK
Practice Address - Zip Code:74012
Practice Address - Country:US
Practice Address - Phone:918-449-3720
Practice Address - Fax:918-449-3725
Is Sole Proprietor?:No
Enumeration Date:2012-11-27
Last Update Date:2020-06-02
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
OK2201363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant