Provider Demographics
NPI:1205513827
Name:SLATTERY, NATASHA MARIE (RN)
Entity type:Individual
Prefix:MRS
First Name:NATASHA
Middle Name:MARIE
Last Name:SLATTERY
Suffix:
Gender:F
Credentials:RN
Other - Prefix:MISS
Other - First Name:NATASHA
Other - Middle Name:MARIE
Other - Last Name:NEUKIRCHEN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RN
Mailing Address - Street 1:5811 REDDIN RD
Mailing Address - Street 2:
Mailing Address - City:RUDOLPH
Mailing Address - State:WI
Mailing Address - Zip Code:54475-9593
Mailing Address - Country:US
Mailing Address - Phone:715-451-3809
Mailing Address - Fax:
Practice Address - Street 1:5811 REDDIN RD
Practice Address - Street 2:
Practice Address - City:RUDOLPH
Practice Address - State:WI
Practice Address - Zip Code:54475-9593
Practice Address - Country:US
Practice Address - Phone:715-451-3809
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-07-05
Last Update Date:2023-07-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
251J00000X
WI220417163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse
No251J00000XAgenciesNursing Care