Provider Demographics
NPI:1326202953
Name:FAIR, NATASHA NICOLE (PA-C)
Entity Type:Individual
Prefix:MRS
First Name:NATASHA
Middle Name:NICOLE
Last Name:FAIR
Suffix:
Gender:F
Credentials:PA-C
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Mailing Address - Street 1:2700 BAKER ST FL 3
Mailing Address - Street 2:
Mailing Address - City:MUSKEGON HEIGHTS
Mailing Address - State:MI
Mailing Address - Zip Code:49444-2157
Mailing Address - Country:US
Mailing Address - Phone:231-737-1335
Mailing Address - Fax:231-737-0534
Practice Address - Street 1:2700 BAKER ST FL 3
Practice Address - Street 2:
Practice Address - City:MUSKEGON HEIGHTS
Practice Address - State:MI
Practice Address - Zip Code:49444-2157
Practice Address - Country:US
Practice Address - Phone:231-737-1335
Practice Address - Fax:231-737-0534
Is Sole Proprietor?:No
Enumeration Date:2008-07-13
Last Update Date:2022-01-02
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
MI5601005337363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI231858Medicare Oscar/Certification