Provider Demographics
NPI:1336795061
Name:MCGILL, NATASHA EVON (LPN)
Entity Type:Individual
Prefix:
First Name:NATASHA
Middle Name:EVON
Last Name:MCGILL
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12958 HIGH CREST ST
Mailing Address - Street 2:
Mailing Address - City:BLACK JACK
Mailing Address - State:MO
Mailing Address - Zip Code:63033-4552
Mailing Address - Country:US
Mailing Address - Phone:314-258-1268
Mailing Address - Fax:
Practice Address - Street 1:12958 HIGH CREST ST
Practice Address - Street 2:
Practice Address - City:BLACK JACK
Practice Address - State:MO
Practice Address - Zip Code:63033-4552
Practice Address - Country:US
Practice Address - Phone:314-258-1268
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-08-19
Last Update Date:2019-08-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2016003867164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse