MEDICARE: DR. NELLY AIMEE VANZETTI PH.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	103TC0700X	Clinical Psychologist	604	OK

General Provider Information

NPI Number	:	1982653374
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. NELLY AIMEE VANZETTI PH.D.

Provider Business Mailing Address
First Line	:	4870 S LEWIS AVE
Second Line	:	SUITE 125
City	:	TULSA
State	:	OK
Zip	:	74105-5151
Country	:	US
Telephone Number	:	918-743-7446
Fax Number	:	918-746-0573

Provider Business Practice Location Address
First Line	:	4870 S LEWIS AVE
Second Line	:	SUITE 125
City	:	TULSA
State	:	OK
Zip	:	74105-5151
Country	:	US
Telephone Number	:	918-743-7446
Fax Number	:	918-746-0573

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/10/2006
Last Update Date	:	08/19/2008

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