Provider Demographics
NPI:1528316304
Name:WALLGREN, NATASHA DAWN
Entity type:Individual
Prefix:MS
First Name:NATASHA
Middle Name:DAWN
Last Name:WALLGREN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10765 WOODSIDE AVE STE B
Mailing Address - Street 2:
Mailing Address - City:SANTEE
Mailing Address - State:CA
Mailing Address - Zip Code:92071-8104
Mailing Address - Country:US
Mailing Address - Phone:619-456-9609
Mailing Address - Fax:
Practice Address - Street 1:10765 WOODSIDE AVE STE B
Practice Address - Street 2:
Practice Address - City:SANTEE
Practice Address - State:CA
Practice Address - Zip Code:92071-8104
Practice Address - Country:US
Practice Address - Phone:619-456-9609
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-08-27
Last Update Date:2012-08-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator