Provider Demographics
NPI:1801377023
Name:WEGESA, NATASHA DAMARA (AGCNS-BC)
Entity Type:Individual
Prefix:MRS
First Name:NATASHA
Middle Name:DAMARA
Last Name:WEGESA
Suffix:
Gender:F
Credentials:AGCNS-BC
Other - Prefix:MRS
Other - First Name:NATASHA
Other - Middle Name:DAMARA WEGESA
Other - Last Name:MOTONGO
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:3000 N. IH-35, SUITE 700
Mailing Address - Street 2:
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78705
Mailing Address - Country:US
Mailing Address - Phone:512-807-3150
Mailing Address - Fax:512-458-7879
Practice Address - Street 1:3000 N. IH-35, SUITE 700
Practice Address - Street 2:
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78705
Practice Address - Country:US
Practice Address - Phone:512-807-3150
Practice Address - Fax:512-458-7879
Is Sole Proprietor?:No
Enumeration Date:2018-08-25
Last Update Date:2022-04-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXAP138594364SG0600X, 364SA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes364SA2200XPhysician Assistants & Advanced Practice Nursing ProvidersClinical Nurse SpecialistAdult Health
No364SG0600XPhysician Assistants & Advanced Practice Nursing ProvidersClinical Nurse SpecialistGerontology