Provider Demographics
NPI:1891243416
Name:BREEN, NATASHA (PA-C)
Entity Type:Individual
Prefix:MRS
First Name:NATASHA
Middle Name:
Last Name:BREEN
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:MISS
Other - First Name:NATASHA
Other - Middle Name:
Other - Last Name:NECAS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 858
Mailing Address - Street 2:MC A410
Mailing Address - City:HERSHEY
Mailing Address - State:PA
Mailing Address - Zip Code:17033-0858
Mailing Address - Country:US
Mailing Address - Phone:800-243-1455
Mailing Address - Fax:
Practice Address - Street 1:500 UNIVERSITY DR
Practice Address - Street 2:
Practice Address - City:HERSHEY
Practice Address - State:PA
Practice Address - Zip Code:17033
Practice Address - Country:US
Practice Address - Phone:717-531-6585
Practice Address - Fax:717-531-0395
Is Sole Proprietor?:No
Enumeration Date:2016-09-12
Last Update Date:2018-07-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOA003883363AM0700X
PAMA058452363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA652261OtherMEDICARE
PA103208964Medicaid