Provider Demographics
NPI:1346495124
Name:VASSAR, NATALIE WAKEFIELD (MD)
Entity Type:Individual
Prefix:DR
First Name:NATALIE
Middle Name:WAKEFIELD
Last Name:VASSAR
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:7714 S INDIAN AVE
Mailing Address - Street 2:
Mailing Address - City:TULSA
Mailing Address - State:OK
Mailing Address - Zip Code:74132-2841
Mailing Address - Country:US
Mailing Address - Phone:918-645-2018
Mailing Address - Fax:918-612-9972
Practice Address - Street 1:9410 S ELWOOD AVE STE 101
Practice Address - Street 2:
Practice Address - City:JENKS
Practice Address - State:OK
Practice Address - Zip Code:74037-2366
Practice Address - Country:US
Practice Address - Phone:918-401-0772
Practice Address - Fax:918-612-9972
Is Sole Proprietor?:No
Enumeration Date:2008-11-20
Last Update Date:2023-08-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK264542084P0015X, 2084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
No2084P0015XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychosomatic Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK200225570AMedicaid
OK200225570AMedicaid