Provider Demographics
NPI:1689096257
Name:WARMUTH, NATALIE ELIZABETH (PA-C)
Entity Type:Individual
Prefix:MRS
First Name:NATALIE
Middle Name:ELIZABETH
Last Name:WARMUTH
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:MS
Other - First Name:NATALIE
Other - Middle Name:ELIZABETH
Other - Last Name:CHURCH
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:830 WEST DIVERSEY PKWY.
Mailing Address - Street 2:SUITE 300
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60614-8711
Mailing Address - Country:US
Mailing Address - Phone:773-248-4150
Mailing Address - Fax:773-248-4291
Practice Address - Street 1:830 WEST DIVERSEY PKWY.
Practice Address - Street 2:SUITE 300
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60614-8711
Practice Address - Country:US
Practice Address - Phone:773-248-4150
Practice Address - Fax:773-248-4291
Is Sole Proprietor?:No
Enumeration Date:2014-01-15
Last Update Date:2016-05-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL085004848363AS0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgical