Provider Demographics
NPI:1225618168
Name:WALOVEN, NATASHA (NP)
Entity Type:Individual
Prefix:
First Name:NATASHA
Middle Name:
Last Name:WALOVEN
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:NATAHSA
Other - Middle Name:
Other - Last Name:VISCO
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:NP
Mailing Address - Street 1:101 W UTICA ST STE A
Mailing Address - Street 2:
Mailing Address - City:OSWEGO
Mailing Address - State:NY
Mailing Address - Zip Code:13126-3167
Mailing Address - Country:US
Mailing Address - Phone:315-532-5053
Mailing Address - Fax:888-827-9682
Practice Address - Street 1:101 W UTICA ST STE A
Practice Address - Street 2:
Practice Address - City:OSWEGO
Practice Address - State:NY
Practice Address - Zip Code:13126-3167
Practice Address - Country:US
Practice Address - Phone:315-216-4871
Practice Address - Fax:888-827-9682
Is Sole Proprietor?:No
Enumeration Date:2021-04-14
Last Update Date:2021-04-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYF347563-01363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily