Provider Demographics
NPI:1629339114
Name:FAULKNER, VANESSA
Entity Type:Individual
Prefix:MRS
First Name:VANESSA
Middle Name:
Last Name:FAULKNER
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 1:3308 W 61ST ST
Mailing Address - Street 2:
Mailing Address - City:TULSA
Mailing Address - State:OK
Mailing Address - Zip Code:74132-1223
Mailing Address - Country:US
Mailing Address - Phone:918-445-2900
Mailing Address - Fax:918-445-7711
Practice Address - Street 1:3308 W 61ST ST
Practice Address - Street 2:
Practice Address - City:TULSA
Practice Address - State:OK
Practice Address - Zip Code:74132-1223
Practice Address - Country:US
Practice Address - Phone:918-445-2900
Practice Address - Fax:918-445-7711
Is Sole Proprietor?:No
Enumeration Date:2012-05-31
Last Update Date:2012-05-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator