Healthcare Provider Details

I. General information

NPI: 1821027996
Provider Name (Legal Business Name): NATALIE ANN WASKOWIAK PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/01/2006
Last Update Date: 06/03/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

500 W LEOTA ST SUITE 150
NORTH PLATTE NE
69101-6576
US

IV. Provider business mailing address

2217 AVENUE L
GOTHENBURG NE
69138-2534
US

V. Phone/Fax

Practice location:
  • Phone: 308-532-3022
  • Fax:
Mailing address:
  • Phone: 308-537-7848
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License Number812
License Number StateNE

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: