Provider Demographics
NPI:1760103832
Name:SARTIN, NATOSHA L (PRSS,RCP)
Entity Type:Individual
Prefix:
First Name:NATOSHA
Middle Name:L
Last Name:SARTIN
Suffix:
Gender:F
Credentials:PRSS,RCP
Other - Prefix:
Other - First Name:NATOSHA
Other - Middle Name:LORRAIN
Other - Last Name:VARNEY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 2660
Mailing Address - Street 2:
Mailing Address - City:WILLIAMSON
Mailing Address - State:WV
Mailing Address - Zip Code:25661-2660
Mailing Address - Country:US
Mailing Address - Phone:304-235-0022
Mailing Address - Fax:304-235-0032
Practice Address - Street 1:1 E 2ND AVE
Practice Address - Street 2:
Practice Address - City:WILLIAMSON
Practice Address - State:WV
Practice Address - Zip Code:25661-3503
Practice Address - Country:US
Practice Address - Phone:304-235-0022
Practice Address - Fax:304-235-0032
Is Sole Proprietor?:Yes
Enumeration Date:2022-09-07
Last Update Date:2022-10-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV175T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes175T00000XOther Service ProvidersPeer SpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WV1760103832Medicaid