Healthcare Provider Details

I. General information

NPI: 1700134293
Provider Name (Legal Business Name): NATHALIE JEAN MD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/15/2012
Last Update Date: 06/05/2026
Certification Date: 06/05/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

105 W 8TH AVE STE 1000
SPOKANE WA
99204-2327
US

IV. Provider business mailing address

607 S 24TH AVE # 367
WAUSAU WI
54401-5226
US

V. Phone/Fax

Practice location:
  • Phone: 509-474-4500
  • Fax: 509-227-7070
Mailing address:
  • Phone: 347-421-2862
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207RN0300X
TaxonomyNephrology Physician
License Number72878
License Number StateWI
# 2
Primary TaxonomyN
Taxonomy Code207RN0300X
TaxonomyNephrology Physician
License NumberME150999
License Number StateFL
# 3
Primary TaxonomyY
Taxonomy Code207RN0300X
TaxonomyNephrology Physician
License NumberMD61260915
License Number StateWA
# 4
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number036.152627
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: