Provider Demographics
NPI:1023137163
Name:MARKS, NATALIE R (PA-C)
Entity type:Individual
Prefix:
First Name:NATALIE
Middle Name:R
Last Name:MARKS
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:NATALIE
Other - Middle Name:R
Other - Last Name:CARLBERG
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PA-C
Mailing Address - Street 1:208 CONCOURSE BLVD
Mailing Address - Street 2:SUITE 1
Mailing Address - City:SANTA ROSA
Mailing Address - State:CA
Mailing Address - Zip Code:95403
Mailing Address - Country:US
Mailing Address - Phone:707-544-3400
Mailing Address - Fax:707-544-0137
Practice Address - Street 1:208 CONCOURSE BLVD
Practice Address - Street 2:SUITE 1
Practice Address - City:SANTA ROSA
Practice Address - State:CA
Practice Address - Zip Code:95403
Practice Address - Country:US
Practice Address - Phone:707-544-3400
Practice Address - Fax:707-544-0137
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-28
Last Update Date:2015-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPA16126363AS0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgical
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAP65614Medicare UPIN