Provider Demographics
NPI:1659692689
Name:THEANO, NATACHA
Entity Type:Individual
Prefix:
First Name:NATACHA
Middle Name:
Last Name:THEANO
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1525 BANTAM PL
Mailing Address - Street 2:
Mailing Address - City:BRONX
Mailing Address - State:NY
Mailing Address - Zip Code:10469-5928
Mailing Address - Country:US
Mailing Address - Phone:347-920-3521
Mailing Address - Fax:
Practice Address - Street 1:1525 BANTAM PL
Practice Address - Street 2:
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10469-5928
Practice Address - Country:US
Practice Address - Phone:347-920-3521
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-06-14
Last Update Date:2010-06-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY615048163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse