Healthcare Provider Details

I. General information

NPI: 1063102820
Provider Name (Legal Business Name): NATALIE HEURTELOU
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/15/2023
Last Update Date: 05/15/2023
Certification Date: 05/13/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

240 S 40TH ST
PHILADELPHIA PA
19104-6030
US

IV. Provider business mailing address

218 SOUTH ST APT 1
BOSTON MA
02130-3940
US

V. Phone/Fax

Practice location:
  • Phone: 215-573-2588
  • Fax:
Mailing address:
  • Phone: 973-295-2548
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: