Healthcare Provider Details

I. General information

NPI: 1285927376
Provider Name (Legal Business Name): NATALIE MARIE HANSEN RDH
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: MS. NATALIE MARIE SOARES

II. Dates (important events)

Enumeration Date: 05/23/2011
Last Update Date: 05/23/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

73265 CONFEDERATED WAY
PENDLETON OR
97801
US

IV. Provider business mailing address

69363 LANTZ LN
COVE OR
97824-8208
US

V. Phone/Fax

Practice location:
  • Phone: 541-966-9830
  • Fax: 541-278-7572
Mailing address:
  • Phone: 541-805-9561
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code124Q00000X
TaxonomyDental Hygienist
License NumberH5233
License Number StateOR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: