Provider Demographics
NPI:1780926725
Name:PRYMAK, NATASHA (NP)
Entity type:Individual
Prefix:
First Name:NATASHA
Middle Name:
Last Name:PRYMAK
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 3910
Mailing Address - Street 2:
Mailing Address - City:FREDERICKSBURG
Mailing Address - State:VA
Mailing Address - Zip Code:22402-3910
Mailing Address - Country:US
Mailing Address - Phone:540-785-9900
Mailing Address - Fax:
Practice Address - Street 1:4510 PLANK RD
Practice Address - Street 2:SUITE # 200
Practice Address - City:FREDERICKSBURG
Practice Address - State:VA
Practice Address - Zip Code:22407-0138
Practice Address - Country:US
Practice Address - Phone:540-785-9900
Practice Address - Fax:540-785-9960
Is Sole Proprietor?:No
Enumeration Date:2013-03-17
Last Update Date:2014-03-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0024170745363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA332127YWAUMedicare PIN
VAVV9485B - C03895Medicare PIN