Healthcare Provider Details

I. General information

NPI: 1023770575
Provider Name (Legal Business Name): NOEL MAZZEI
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/12/2021
Last Update Date: 10/12/2021
Certification Date: 10/12/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2121 S 125TH EAST AVE STE 106
TULSA OK
74129-5800
US

IV. Provider business mailing address

2121 S 125TH EAST AVE STE 106
TULSA OK
74129-5800
US

V. Phone/Fax

Practice location:
  • Phone: 918-574-8442
  • Fax: 918-591-3955
Mailing address:
  • Phone: 918-574-8442
  • Fax: 918-591-3955

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number
License Number StateOK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: