Provider Demographics
NPI:1114403250
Name:ANDERSON, NATASHA LYNN (LPN)
Entity Type:Individual
Prefix:MRS
First Name:NATASHA
Middle Name:LYNN
Last Name:ANDERSON
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:MRS
Other - First Name:NATASHA
Other - Middle Name:LYNN
Other - Last Name:ANDERSON
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:NATASHA ANDERSON LPN
Mailing Address - Street 1:64 TECUMSEH DR
Mailing Address - Street 2:
Mailing Address - City:HAMILTON
Mailing Address - State:OH
Mailing Address - Zip Code:45013-1541
Mailing Address - Country:US
Mailing Address - Phone:513-544-6185
Mailing Address - Fax:
Practice Address - Street 1:64 TECUMSEH DR
Practice Address - Street 2:
Practice Address - City:HAMILTON
Practice Address - State:OH
Practice Address - Zip Code:45013-1541
Practice Address - Country:US
Practice Address - Phone:513-544-6185
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-07-12
Last Update Date:2018-07-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH133655164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH$$$$$$$$$OtherSOCIAL