Provider Demographics
NPI:1720473176
Name:COSELLI, NATALIE WARE (PA-C)
Entity Type:Individual
Prefix:
First Name:NATALIE
Middle Name:WARE
Last Name:COSELLI
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6701 FANNIN ST STE 12010
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77030-2608
Mailing Address - Country:US
Mailing Address - Phone:832-822-3135
Mailing Address - Fax:
Practice Address - Street 1:6701 FANNIN ST STE 12010
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77030-2608
Practice Address - Country:US
Practice Address - Phone:832-822-3135
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-04-02
Last Update Date:2019-06-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
363A00000X
TXPA09829363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX8223MAOtherBCBS
TX346394502Medicaid
TX346394501Medicaid
TX346394501Medicaid
TX538760ZSWDMedicare PIN