Healthcare Provider Details

I. General information

NPI: 1396615779
Provider Name (Legal Business Name): NATASHA DIA EMERICK CRNA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/10/2025
Last Update Date: 06/05/2026
Certification Date: 06/05/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6501 N 19TH AVE
PHOENIX AZ
85015-1602
US

IV. Provider business mailing address

6877 BOSTON DR
NEWBURGH IN
47630-9153
US

V. Phone/Fax

Practice location:
  • Phone: 928-877-0526
  • Fax:
Mailing address:
  • Phone: 260-271-9509
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License Number336736
License Number StateAZ
# 2
Primary TaxonomyN
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License Number28252347A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: