Provider Demographics
NPI:1619577871
Name:ELLINGER, NATALIE MARIE (FNP-C)
Entity Type:Individual
Prefix:
First Name:NATALIE
Middle Name:MARIE
Last Name:ELLINGER
Suffix:
Gender:F
Credentials:FNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1624 PACIFIC AVE STE B
Mailing Address - Street 2:
Mailing Address - City:NATRONA HEIGHTS
Mailing Address - State:PA
Mailing Address - Zip Code:15065-2145
Mailing Address - Country:US
Mailing Address - Phone:724-226-3345
Mailing Address - Fax:724-226-2415
Practice Address - Street 1:1624 PACIFIC AVE STE B
Practice Address - Street 2:
Practice Address - City:NATRONA HEIGHTS
Practice Address - State:PA
Practice Address - Zip Code:15065-2145
Practice Address - Country:US
Practice Address - Phone:724-226-3345
Practice Address - Fax:724-226-2415
Is Sole Proprietor?:Yes
Enumeration Date:2020-10-27
Last Update Date:2024-04-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PASP023086363LF0000X, 363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
15124577OtherCAQH
PA103887844Medicaid