Provider Demographics
NPI:1275706590
Name:NOTZ, NATASH ANA (RN)
Entity Type:Individual
Prefix:MRS
First Name:NATASH
Middle Name:ANA
Last Name:NOTZ
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14004 NEWTON RD
Mailing Address - Street 2:
Mailing Address - City:VALDERS
Mailing Address - State:WI
Mailing Address - Zip Code:54245-9791
Mailing Address - Country:US
Mailing Address - Phone:920-758-3079
Mailing Address - Fax:920-758-3081
Practice Address - Street 1:14004 NEWTON RD
Practice Address - Street 2:
Practice Address - City:VALDERS
Practice Address - State:WI
Practice Address - Zip Code:54245-9791
Practice Address - Country:US
Practice Address - Phone:920-758-3079
Practice Address - Fax:920-758-3081
Is Sole Proprietor?:Yes
Enumeration Date:2008-04-08
Last Update Date:2008-04-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI35044000Medicaid