Provider Demographics
NPI:1962733527
Name:TADDEI, IVO (ANP RX)
Entity type:Individual
Prefix:
First Name:IVO
Middle Name:
Last Name:TADDEI
Suffix:
Gender:M
Credentials:ANP RX
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9940 E 81ST ST STE 100
Mailing Address - Street 2:
Mailing Address - City:TULSA
Mailing Address - State:OK
Mailing Address - Zip Code:74133-4501
Mailing Address - Country:US
Mailing Address - Phone:918-664-9881
Mailing Address - Fax:918-403-6433
Practice Address - Street 1:9940 E 81ST ST STE 100
Practice Address - Street 2:
Practice Address - City:TULSA
Practice Address - State:OK
Practice Address - Zip Code:74133
Practice Address - Country:US
Practice Address - Phone:918-664-9881
Practice Address - Fax:918-403-6433
Is Sole Proprietor?:No
Enumeration Date:2010-01-21
Last Update Date:2018-06-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK83359363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily