Healthcare Provider Details

I. General information

NPI: 1366193856
Provider Name (Legal Business Name): NATALIE SAN LUIS
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/16/2022
Last Update Date: 04/19/2024
Certification Date: 04/19/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7426 W BONNIE PL
KENNEWICK WA
99336-1124
US

IV. Provider business mailing address

3455 SW US VETERANS HOSPITAL RD
PORTLAND OR
97239-3076
US

V. Phone/Fax

Practice location:
  • Phone: 866-904-7721
  • Fax:
Mailing address:
  • Phone: 512-496-4464
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163WW0101X
TaxonomyAmbulatory Women's Health Care Registered Nurse
License NumberRN61261738
License Number StateWA
# 2
Primary TaxonomyN
Taxonomy Code163WC1500X
TaxonomyCommunity Health Registered Nurse
License Number202008994RN
License Number StateOR
# 3
Primary TaxonomyN
Taxonomy Code363LX0001X
TaxonomyObstetrics & Gynecology Nurse Practitioner
License Number10013337
License Number StateOR
# 4
Primary TaxonomyN
Taxonomy Code367A00000X
TaxonomyAdvanced Practice Midwife
License Number10013337
License Number StateOR
# 5
Primary TaxonomyY
Taxonomy Code367A00000X
TaxonomyAdvanced Practice Midwife
License NumberAP61465947
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: