Provider Demographics
NPI:1275267379
Name:JUAREZ, NANCY VIVIANA
Entity Type:Individual
Prefix:
First Name:NANCY
Middle Name:VIVIANA
Last Name:JUAREZ
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10948 E 23RD ST
Mailing Address - Street 2:
Mailing Address - City:TULSA
Mailing Address - State:OK
Mailing Address - Zip Code:74129-5000
Mailing Address - Country:US
Mailing Address - Phone:918-409-5415
Mailing Address - Fax:
Practice Address - Street 1:10948 E 23RD ST
Practice Address - Street 2:
Practice Address - City:TULSA
Practice Address - State:OK
Practice Address - Zip Code:74129-5000
Practice Address - Country:US
Practice Address - Phone:918-409-5415
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-07-13
Last Update Date:2022-07-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes175T00000XOther Service ProvidersPeer Specialist