Provider Demographics
NPI:1467256719
Name:GAINES, NATASHA RENEE
Entity type:Individual
Prefix:MRS
First Name:NATASHA
Middle Name:RENEE
Last Name:GAINES
Suffix:
Gender:
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:99 GREEN ACRES RD
Mailing Address - Street 2:
Mailing Address - City:WASHINGTON
Mailing Address - State:IN
Mailing Address - Zip Code:47501-1216
Mailing Address - Country:US
Mailing Address - Phone:812-617-1150
Mailing Address - Fax:
Practice Address - Street 1:102 E VAN TREES ST
Practice Address - Street 2:
Practice Address - City:WASHINGTON
Practice Address - State:IN
Practice Address - Zip Code:47501-2943
Practice Address - Country:US
Practice Address - Phone:812-617-6005
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-04-03
Last Update Date:2025-04-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN28252294A163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse