Provider Demographics
NPI:1598365264
Name:COMPEAU, NATASHA (CNA)
Entity Type:Individual
Prefix:
First Name:NATASHA
Middle Name:
Last Name:COMPEAU
Suffix:
Gender:F
Credentials:CNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:309 RANSOM AVE
Mailing Address - Street 2:
Mailing Address - City:NIAGARA
Mailing Address - State:ND
Mailing Address - Zip Code:58266-6611
Mailing Address - Country:US
Mailing Address - Phone:701-215-8531
Mailing Address - Fax:
Practice Address - Street 1:1115 26TH AVE S APT 20
Practice Address - Street 2:
Practice Address - City:GRAND FORKS
Practice Address - State:ND
Practice Address - Zip Code:58201-7074
Practice Address - Country:US
Practice Address - Phone:701-317-5685
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-10-30
Last Update Date:2020-10-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ND67222251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
ND1451548Medicaid