Provider Demographics
NPI:1730631292
Name:DEBURGER, NATALIE RAE (CAA)
Entity type:Individual
Prefix:
First Name:NATALIE
Middle Name:RAE
Last Name:DEBURGER
Suffix:
Gender:F
Credentials:CAA
Other - Prefix:
Other - First Name:NATALIE
Other - Middle Name:R
Other - Last Name:JENKS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:550 UNIVERSITY BLVD # UH0279
Mailing Address - Street 2:
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46202-5149
Mailing Address - Country:US
Mailing Address - Phone:317-274-0275
Mailing Address - Fax:317-274-0256
Practice Address - Street 1:550 UNIVERSITY BLVD # UH0279
Practice Address - Street 2:
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46202-5149
Practice Address - Country:US
Practice Address - Phone:317-274-0275
Practice Address - Fax:317-274-0256
Is Sole Proprietor?:No
Enumeration Date:2016-11-01
Last Update Date:2023-12-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN75000021A367H00000X
COANT.0000095367H00000X
GA8152367H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367H00000XPhysician Assistants & Advanced Practice Nursing ProvidersAnesthesiologist Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN266430697OtherMEDICARE PTAN
IN095200022OtherMEDICARE PTAN