MEDICARE: NATALIE DENNEN ATC, PA-C

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	2255A2300X	Athletic Trainer	AT341	ME
2	363A00000X	Physician Assistant	PA1702	ME
3	363A00000X	Physician Assistant	50.006254RX	OH

General Provider Information

NPI Number	:	1043273998
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	NATALIE DENNEN ATC, PA-C

Provider Business Mailing Address
First Line	:	1 SEAGATE # 800
Second Line	:
City	:	TOLEDO
State	:	OH
Zip	:	43604-1558
Country	:	US
Telephone Number	:	419-291-1420
Fax Number	:	419-214-3841

Provider Business Practice Location Address
First Line	:	3316 NAVARRE AVE STE F
Second Line	:
City	:	OREGON
State	:	OH
Zip	:	43616-3301
Country	:	US
Telephone Number	:	419-291-1420
Fax Number	:	419-214-3841

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

Provider Enumeration Date	:	04/11/2006
Last Update Date	:	07/25/2024

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