Provider Demographics
NPI:1689871147
Name:INGVOLDSTAD-O'NEAL, NATASHA RENEE (MD)
Entity Type:Individual
Prefix:
First Name:NATASHA
Middle Name:RENEE
Last Name:INGVOLDSTAD-O'NEAL
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:NATASHA
Other - Middle Name:RENEE
Other - Last Name:O'NEAL
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:
Mailing Address - Street 1:2595 SW 87TH AVE
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97225-4007
Mailing Address - Country:US
Mailing Address - Phone:503-384-0173
Mailing Address - Fax:
Practice Address - Street 1:100 E 33RD ST
Practice Address - Street 2:SUITE 100
Practice Address - City:VANCOUVER
Practice Address - State:WA
Practice Address - Zip Code:98663-2776
Practice Address - Country:US
Practice Address - Phone:360-514-7550
Practice Address - Fax:360-514-7553
Is Sole Proprietor?:No
Enumeration Date:2007-06-28
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAML20008238207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine