Provider Demographics
NPI:1366032997
Name:WYTRWAL, NATALIA ANNA (PA-C)
Entity Type:Individual
Prefix:
First Name:NATALIA
Middle Name:ANNA
Last Name:WYTRWAL
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:NATALIA
Other - Middle Name:
Other - Last Name:RUSINEK
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PA-C
Mailing Address - Street 1:4035 95TH ST
Mailing Address - Street 2:
Mailing Address - City:ELMHURST
Mailing Address - State:NY
Mailing Address - Zip Code:11373-6206
Mailing Address - Country:US
Mailing Address - Phone:718-316-5481
Mailing Address - Fax:
Practice Address - Street 1:4035 95TH ST
Practice Address - Street 2:
Practice Address - City:ELMHURST
Practice Address - State:NY
Practice Address - Zip Code:11373-6206
Practice Address - Country:US
Practice Address - Phone:718-316-5481
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-01-18
Last Update Date:2023-09-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY025804363AM0700X, 363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
No363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical