Provider Demographics
NPI:1902511512
Name:UNRUH, NATASHA MILENKAYA (ELECTROLOGIST)
Entity Type:Individual
Prefix:
First Name:NATASHA
Middle Name:MILENKAYA
Last Name:UNRUH
Suffix:
Gender:F
Credentials:ELECTROLOGIST
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:481 NE LIBERTY AVE
Mailing Address - Street 2:
Mailing Address - City:GRESHAM
Mailing Address - State:OR
Mailing Address - Zip Code:97030-7947
Mailing Address - Country:US
Mailing Address - Phone:650-814-0154
Mailing Address - Fax:
Practice Address - Street 1:915 NE 2ND ST RM 6
Practice Address - Street 2:
Practice Address - City:GRESHAM
Practice Address - State:OR
Practice Address - Zip Code:97030-7512
Practice Address - Country:US
Practice Address - Phone:650-814-0154
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-01-18
Last Update Date:2023-01-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORBAP-E-10211910174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
ORBAP-E-10211910OtherHEALTH LICENSING OFFICE