Provider Demographics
NPI:1396028296
Name:NEHART, NATALIE (PA-C)
Entity Type:Individual
Prefix:
First Name:NATALIE
Middle Name:
Last Name:NEHART
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3 WESTBROOK CORPORATE CTR
Mailing Address - Street 2:STE 1000
Mailing Address - City:WESTCHESTER
Mailing Address - State:IL
Mailing Address - Zip Code:60154-5703
Mailing Address - Country:US
Mailing Address - Phone:708-343-3566
Mailing Address - Fax:708-409-1429
Practice Address - Street 1:3 WESTBROOK CORPORATE CTR
Practice Address - Street 2:STE 1000
Practice Address - City:WESTCHESTER
Practice Address - State:IL
Practice Address - Zip Code:60154-5703
Practice Address - Country:US
Practice Address - Phone:708-343-3566
Practice Address - Fax:708-409-1429
Is Sole Proprietor?:No
Enumeration Date:2011-09-27
Last Update Date:2011-09-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL085004151363AS0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgical
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL085004151Medicaid