Provider Demographics
NPI:1376911404
Name:SMITH, NATALIE HARDIE (PA-C)
Entity Type:Individual
Prefix:MRS
First Name:NATALIE
Middle Name:HARDIE
Last Name:SMITH
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:MS
Other - First Name:NATALIE
Other - Middle Name:ANNE
Other - Last Name:HARDIE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PA-C
Mailing Address - Street 1:11 CELANO
Mailing Address - Street 2:
Mailing Address - City:LAGUNA NIGUEL
Mailing Address - State:CA
Mailing Address - Zip Code:92677-8616
Mailing Address - Country:US
Mailing Address - Phone:949-280-2811
Mailing Address - Fax:
Practice Address - Street 1:27001 MOULTON PKWY STE A102
Practice Address - Street 2:
Practice Address - City:LAGUNA HILLS
Practice Address - State:CA
Practice Address - Zip Code:92656-3626
Practice Address - Country:US
Practice Address - Phone:949-280-2811
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-09-06
Last Update Date:2018-09-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA52784363AM0700X, 363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
No363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical