Provider Demographics
NPI:1336457571
Name:HAINES, NATASHA (NP)
Entity Type:Individual
Prefix:
First Name:NATASHA
Middle Name:
Last Name:HAINES
Suffix:
Gender:F
Credentials:NP
Other - Prefix:MRS
Other - First Name:NATASHA
Other - Middle Name:
Other - Last Name:PENNOCK
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:NP
Mailing Address - Street 1:116 E BALSAM ST
Mailing Address - Street 2:
Mailing Address - City:LIBBY
Mailing Address - State:MT
Mailing Address - Zip Code:59923-2402
Mailing Address - Country:US
Mailing Address - Phone:406-334-4550
Mailing Address - Fax:
Practice Address - Street 1:116 E BALSAM ST
Practice Address - Street 2:
Practice Address - City:LIBBY
Practice Address - State:MT
Practice Address - Zip Code:59923-2402
Practice Address - Country:US
Practice Address - Phone:406-334-4550
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-09-22
Last Update Date:2016-09-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MT31522363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner