Provider Demographics
NPI:1275839508
Name:MCNALLY, NATALIE MARIE (NP)
Entity Type:Individual
Prefix:MS
First Name:NATALIE
Middle Name:MARIE
Last Name:MCNALLY
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:NATALIE
Other - Middle Name:MARIE
Other - Last Name:RAY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:477 N EL CAMINO REAL
Mailing Address - Street 2:SUITE B105
Mailing Address - City:ENCINITAS
Mailing Address - State:CA
Mailing Address - Zip Code:92024-1328
Mailing Address - Country:US
Mailing Address - Phone:760-753-7143
Mailing Address - Fax:760-753-2155
Practice Address - Street 1:477 N EL CAMINO REAL
Practice Address - Street 2:SUITE B105
Practice Address - City:ENCINITAS
Practice Address - State:CA
Practice Address - Zip Code:92024-1328
Practice Address - Country:US
Practice Address - Phone:760-753-7143
Practice Address - Fax:760-753-2155
Is Sole Proprietor?:No
Enumeration Date:2011-02-03
Last Update Date:2011-02-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA20306363LP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics