Provider Demographics
NPI:1720339682
Name:BENDER, NATOYA NICOLA (NP-C)
Entity Type:Individual
Prefix:MISS
First Name:NATOYA
Middle Name:NICOLA
Last Name:BENDER
Suffix:
Gender:F
Credentials:NP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3630 EDENBOURGH PL
Mailing Address - Street 2:
Mailing Address - City:MARIETTA
Mailing Address - State:GA
Mailing Address - Zip Code:30066-3081
Mailing Address - Country:US
Mailing Address - Phone:404-388-4800
Mailing Address - Fax:
Practice Address - Street 1:3630 EDENBOURGH PL
Practice Address - Street 2:
Practice Address - City:MARIETTA
Practice Address - State:GA
Practice Address - Zip Code:30066-3081
Practice Address - Country:US
Practice Address - Phone:404-388-4800
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-10-01
Last Update Date:2012-10-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARN172939363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health