Provider Demographics
NPI:1902110216
Name:SILL, NATASHA BETTINA (CPNP)
Entity Type:Individual
Prefix:
First Name:NATASHA
Middle Name:BETTINA
Last Name:SILL
Suffix:
Gender:F
Credentials:CPNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1381 UNIVERSITY ST
Mailing Address - Street 2:
Mailing Address - City:HEALDSBURG
Mailing Address - State:CA
Mailing Address - Zip Code:95448-3314
Mailing Address - Country:US
Mailing Address - Phone:707-433-5494
Mailing Address - Fax:707-431-8649
Practice Address - Street 1:1381 UNIVERSITY ST
Practice Address - Street 2:
Practice Address - City:HEALDSBURG
Practice Address - State:CA
Practice Address - Zip Code:95448
Practice Address - Country:US
Practice Address - Phone:707-433-5494
Practice Address - Fax:707-431-8649
Is Sole Proprietor?:No
Enumeration Date:2010-07-28
Last Update Date:2018-05-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA19946363LP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics