Provider Demographics
NPI:1710350053
Name:MACEUS, NATACHA
Entity Type:Individual
Prefix:
First Name:NATACHA
Middle Name:
Last Name:MACEUS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:NATACHA
Other - Middle Name:
Other - Last Name:MACEUS
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:RN
Mailing Address - Street 1:1315 E 46TH ST
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11234-2001
Mailing Address - Country:US
Mailing Address - Phone:347-256-2364
Mailing Address - Fax:
Practice Address - Street 1:1315 E 46TH ST
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11234-2001
Practice Address - Country:US
Practice Address - Phone:347-256-2364
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-11-09
Last Update Date:2015-11-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY706465163W00000X
NY306704164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse
No164W00000XNursing Service ProvidersLicensed Practical Nurse