Provider Demographics
NPI:1821027996
Name:WASKOWIAK, NATALIE ANN (PA-C)
Entity Type:Individual
Prefix:
First Name:NATALIE
Middle Name:ANN
Last Name:WASKOWIAK
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2217 AVENUE L
Mailing Address - Street 2:
Mailing Address - City:GOTHENBURG
Mailing Address - State:NE
Mailing Address - Zip Code:69138-2534
Mailing Address - Country:US
Mailing Address - Phone:308-537-7848
Mailing Address - Fax:
Practice Address - Street 1:500 W LEOTA ST
Practice Address - Street 2:SUITE 150
Practice Address - City:NORTH PLATTE
Practice Address - State:NE
Practice Address - Zip Code:69101-6576
Practice Address - Country:US
Practice Address - Phone:308-532-3022
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-07-01
Last Update Date:2009-06-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE812363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical