Provider Demographics
NPI:1982653374
Name:VANZETTI, NELLY AIMEE (PHD)
Entity Type:Individual
Prefix:DR
First Name:NELLY
Middle Name:AIMEE
Last Name:VANZETTI
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:4870 S LEWIS AVE
Mailing Address - Street 2:SUITE 125
Mailing Address - City:TULSA
Mailing Address - State:OK
Mailing Address - Zip Code:74105-5151
Mailing Address - Country:US
Mailing Address - Phone:918-743-7446
Mailing Address - Fax:918-746-0573
Practice Address - Street 1:4870 S LEWIS AVE
Practice Address - Street 2:SUITE 125
Practice Address - City:TULSA
Practice Address - State:OK
Practice Address - Zip Code:74105-5151
Practice Address - Country:US
Practice Address - Phone:918-743-7446
Practice Address - Fax:918-746-0573
Is Sole Proprietor?:No
Enumeration Date:2006-05-10
Last Update Date:2008-08-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK604103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical