Healthcare Provider Details

I. General information

NPI: 1619966355
Provider Name (Legal Business Name): NATALIA NAZARTCHOUK NP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/16/2005
Last Update Date: 04/30/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

870 S FRONT ST SUITE 200
CENTRAL POINT OR
97502-2779
US

IV. Provider business mailing address

PO BOX 3158
PORTLAND OR
97208-3158
US

V. Phone/Fax

Practice location:
  • Phone: 541-664-3346
  • Fax: 541-664-6051
Mailing address:
  • Phone: 541-664-3346
  • Fax: 541-664-6051

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number600771
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number13823
License Number StateCA
# 3
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number201150045 NP
License Number StateOR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: