Provider Demographics
NPI:1417973488
Name:NORDHAUGEN, NATALIE ANNE (NP)
Entity Type:Individual
Prefix:MS
First Name:NATALIE
Middle Name:ANNE
Last Name:NORDHAUGEN
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 5940
Mailing Address - Street 2:5409 W. BERYL AVE
Mailing Address - City:GLENDALE
Mailing Address - State:AZ
Mailing Address - Zip Code:85312-5940
Mailing Address - Country:US
Mailing Address - Phone:623-551-6092
Mailing Address - Fax:623-551-5212
Practice Address - Street 1:3618 W ANTHEM WAY STE D120
Practice Address - Street 2:
Practice Address - City:ANTHEM
Practice Address - State:AZ
Practice Address - Zip Code:85086-0458
Practice Address - Country:US
Practice Address - Phone:623-551-5212
Practice Address - Fax:623-551-5212
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-14
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
AZRN052264363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health