Healthcare Provider Details

I. General information

NPI: 1558035386
Provider Name (Legal Business Name): NATASHA HARTWEG PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/05/2021
Last Update Date: 11/13/2022
Certification Date: 11/13/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

615 LILLY RD NE STE 220
OLYMPIA WA
98506-5137
US

IV. Provider business mailing address

615 LILLY RD NE STE 220
OLYMPIA WA
98506-5137
US

V. Phone/Fax

Practice location:
  • Phone: 360-486-6150
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License NumberTA61352420
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: