Provider Demographics
NPI:1598545956
Name:CIAVOLINO, NATALIE ANNE (PA-C)
Entity Type:Individual
Prefix:
First Name:NATALIE
Middle Name:ANNE
Last Name:CIAVOLINO
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:NATALIE
Other - Middle Name:ANNE
Other - Last Name:DEEMS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1120 N CLEVELAND ST APT 5206
Mailing Address - Street 2:
Mailing Address - City:ENID
Mailing Address - State:OK
Mailing Address - Zip Code:73703-3218
Mailing Address - Country:US
Mailing Address - Phone:240-587-1768
Mailing Address - Fax:
Practice Address - Street 1:220 S VAN BUREN ST
Practice Address - Street 2:
Practice Address - City:ENID
Practice Address - State:OK
Practice Address - Zip Code:73703-5812
Practice Address - Country:US
Practice Address - Phone:580-234-9355
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-10-03
Last Update Date:2023-10-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant