Provider Demographics
NPI:1659656593
Name:ORTIZ PATE, NATHALIE ELIZABETH (PA-C)
Entity Type:Individual
Prefix:MRS
First Name:NATHALIE
Middle Name:ELIZABETH
Last Name:ORTIZ PATE
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:MS
Other - First Name:NATHALIE
Other - Middle Name:
Other - Last Name:WENZELL ORTIZ
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PA-C
Mailing Address - Street 1:PO BOX 319
Mailing Address - Street 2:
Mailing Address - City:MONCURE
Mailing Address - State:NC
Mailing Address - Zip Code:27559-0319
Mailing Address - Country:US
Mailing Address - Phone:919-542-4991
Mailing Address - Fax:
Practice Address - Street 1:7228 PITTSBORO-MONCURE RD
Practice Address - Street 2:
Practice Address - City:MONCURE
Practice Address - State:NC
Practice Address - Zip Code:27559
Practice Address - Country:US
Practice Address - Phone:919-542-4991
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-10-11
Last Update Date:2011-10-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC001003139363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical