Provider Demographics
NPI:1306007869
Name:IMBIER, NATALIE (LNM)
Entity Type:Individual
Prefix:MS
First Name:NATALIE
Middle Name:
Last Name:IMBIER
Suffix:
Gender:F
Credentials:LNM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:72 W STAFFORD RD # III
Mailing Address - Street 2:
Mailing Address - City:STAFFORD SPRINGS
Mailing Address - State:CT
Mailing Address - Zip Code:06076-1000
Mailing Address - Country:US
Mailing Address - Phone:860-684-5770
Mailing Address - Fax:
Practice Address - Street 1:72 W STAFFORD RD # III
Practice Address - Street 2:
Practice Address - City:STAFFORD SPRINGS
Practice Address - State:CT
Practice Address - Zip Code:06076-1000
Practice Address - Country:US
Practice Address - Phone:860-684-5770
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-06-18
Last Update Date:2011-12-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT000225367A00000X
MARN142756367A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367A00000XPhysician Assistants & Advanced Practice Nursing ProvidersAdvanced Practice Midwife
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA001210102Medicare PIN