Provider Demographics
NPI:1124595749
Name:LANDRY, NATALIE WOLTERS (NP)
Entity Type:Individual
Prefix:
First Name:NATALIE
Middle Name:WOLTERS
Last Name:LANDRY
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:NATALIE
Other - Middle Name:WOLTERS
Other - Last Name:LANDRY
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:NP
Mailing Address - Street 1:7231 SNAPDRAGON LN
Mailing Address - Street 2:
Mailing Address - City:OOLTEWAH
Mailing Address - State:TN
Mailing Address - Zip Code:37363-6580
Mailing Address - Country:US
Mailing Address - Phone:706-819-8145
Mailing Address - Fax:
Practice Address - Street 1:2253 CHAMBLISS AVE NW STE 2012
Practice Address - Street 2:
Practice Address - City:CLEVELAND
Practice Address - State:TN
Practice Address - Zip Code:37311-3861
Practice Address - Country:US
Practice Address - Phone:423-790-3055
Practice Address - Fax:423-790-1487
Is Sole Proprietor?:No
Enumeration Date:2018-11-01
Last Update Date:2024-03-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN22732363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner