Provider Demographics
NPI:1952963449
Name:WOLTER, NATALYA S
Entity Type:Individual
Prefix:
First Name:NATALYA
Middle Name:S
Last Name:WOLTER
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:NATALYA
Other - Middle Name:S
Other - Last Name:LAPTEV
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:105 W 8TH AVE STE 200
Mailing Address - Street 2:
Mailing Address - City:SPOKANE
Mailing Address - State:WA
Mailing Address - Zip Code:99204-2318
Mailing Address - Country:US
Mailing Address - Phone:509-624-9112
Mailing Address - Fax:
Practice Address - Street 1:105 W 8TH AVE STE 200
Practice Address - Street 2:
Practice Address - City:SPOKANE
Practice Address - State:WA
Practice Address - Zip Code:99204-2318
Practice Address - Country:US
Practice Address - Phone:509-624-9112
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-07-03
Last Update Date:2020-04-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAF07190277363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner