MEDICARE: MS. NATALIE ANNE NORDHAUGEN NP

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363LA2200X	Adult Health Nurse Practitioner	RN052264	AZ

General Provider Information

NPI Number	:	1417973488
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. NATALIE ANNE NORDHAUGEN NP

Provider Business Mailing Address
First Line	:	PO BOX 5940
Second Line	:	5409 W. BERYL AVE
City	:	GLENDALE
State	:	AZ
Zip	:	85312-5940
Country	:	US
Telephone Number	:	623-551-6092
Fax Number	:	623-551-5212

Provider Business Practice Location Address
First Line	:	3618 W ANTHEM WAY STE D120
Second Line	:
City	:	ANTHEM
State	:	AZ
Zip	:	85086-0458
Country	:	US
Telephone Number	:	623-551-5212
Fax Number	:	623-551-5212

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/14/2006
Last Update Date	:	07/08/2007

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