Provider Demographics
NPI:1912195447
Name:MENOSSI, NATALIE D (PA)
Entity Type:Individual
Prefix:
First Name:NATALIE
Middle Name:D
Last Name:MENOSSI
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Mailing Address - Street 1:1215 VANDALIA ST
Mailing Address - Street 2:
Mailing Address - City:COLLINSVILLE
Mailing Address - State:IL
Mailing Address - Zip Code:62234-4060
Mailing Address - Country:US
Mailing Address - Phone:618-343-6012
Mailing Address - Fax:618-578-5759
Practice Address - Street 1:1215 VANDALIA ST
Practice Address - Street 2:
Practice Address - City:COLLINSVILLE
Practice Address - State:IL
Practice Address - Zip Code:62234-4060
Practice Address - Country:US
Practice Address - Phone:618-343-6012
Practice Address - Fax:618-578-5759
Is Sole Proprietor?:No
Enumeration Date:2007-10-10
Last Update Date:2024-02-07
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
IL085-002316363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant