Healthcare Provider Details

I. General information

NPI: 1891447009
Provider Name (Legal Business Name): NATALIE JEAN BAINE MSN, RN, CRNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/19/2022
Last Update Date: 01/19/2022
Certification Date: 01/17/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4829 E STREET RD STE 100
FEASTERVILLE TREVOSE PA
19053-6647
US

IV. Provider business mailing address

4829 E STREET RD STE 100
FEASTERVILLE TREVOSE PA
19053-6647
US

V. Phone/Fax

Practice location:
  • Phone: 215-364-5800
  • Fax: 215-364-5899
Mailing address:
  • Phone: 215-364-5800
  • Fax: 215-364-5899

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberSP025182
License Number StatePA

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: