Healthcare Provider Details

I. General information

NPI: 1407764004
Provider Name (Legal Business Name): NATASHA MCCONNELL
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/01/2026
Last Update Date: 09/01/2026
Certification Date: 08/31/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

212 COUNTY HIGHWAY 75A
BERGHOLZ OH
43908
US

IV. Provider business mailing address

1547 COUNTY ROAD 41
RICHMOND OH
43944-6911
US

V. Phone/Fax

Practice location:
  • Phone: 740-282-1469
  • Fax:
Mailing address:
  • Phone: 740-381-2334
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WS0200X
TaxonomySchool Registered Nurse
License NumberRN.378599
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: