Healthcare Provider Details

I. General information

NPI: 1831946003
Provider Name (Legal Business Name): NATALIE BASTARACHE
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/04/2024
Last Update Date: 03/25/2026
Certification Date: 03/25/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

647 13TH AVE E
WEST FARGO ND
58078-3328
US

IV. Provider business mailing address

4844 38TH AVE S
FARGO ND
58104-8514
US

V. Phone/Fax

Practice location:
  • Phone: 701-277-8844
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: