Provider Demographics
NPI:1992022305
Name:ANDRY, NATHALIE VICTORIA (MD)
Entity Type:Individual
Prefix:
First Name:NATHALIE
Middle Name:VICTORIA
Last Name:ANDRY
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:NATHALIE
Other - Middle Name:VICTORIA
Other - Last Name:GEBARA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:4500 S GARNETT RD STE 112
Mailing Address - Street 2:
Mailing Address - City:TULSA
Mailing Address - State:OK
Mailing Address - Zip Code:74146-5201
Mailing Address - Country:US
Mailing Address - Phone:189-353-5509
Mailing Address - Fax:
Practice Address - Street 1:4500 S GARNETT RD STE 112
Practice Address - Street 2:
Practice Address - City:TULSA
Practice Address - State:OK
Practice Address - Zip Code:74146-5201
Practice Address - Country:US
Practice Address - Phone:189-353-5509
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-04-24
Last Update Date:2021-08-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK356722085N0700X
CAA1127962085R0202X
NY602506422085R0202X
AZ458402085N0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085N0700XAllopathic & Osteopathic PhysiciansRadiologyNeuroradiology
No2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA0A1127960Medicaid
CA0A1127960Medicaid