Provider Demographics
NPI:1538308531
Name:GREEN, NATALIE LOREN (PA)
Entity Type:Individual
Prefix:MISS
First Name:NATALIE
Middle Name:LOREN
Last Name:GREEN
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:
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Mailing Address - Street 1:1801 N BROADWAY AVE
Mailing Address - Street 2:
Mailing Address - City:OKLAHOMA CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73103-3446
Mailing Address - Country:US
Mailing Address - Phone:405-528-1936
Mailing Address - Fax:405-528-8260
Practice Address - Street 1:1801 N BROADWAY AVE
Practice Address - Street 2:
Practice Address - City:OKLAHOMA CITY
Practice Address - State:OK
Practice Address - Zip Code:73103-3446
Practice Address - Country:US
Practice Address - Phone:405-528-1936
Practice Address - Fax:405-528-8260
Is Sole Proprietor?:No
Enumeration Date:2009-02-13
Last Update Date:2009-02-13
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
OK1800363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant