Provider Demographics
NPI:1801264031
Name:MORTIMER, NATALYA L (ARNP, PMHNP)
Entity type:Individual
Prefix:
First Name:NATALYA
Middle Name:L
Last Name:MORTIMER
Suffix:
Gender:F
Credentials:ARNP, PMHNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1151 CRENSHAW RD
Mailing Address - Street 2:
Mailing Address - City:EUGENE
Mailing Address - State:OR
Mailing Address - Zip Code:97401-2022
Mailing Address - Country:US
Mailing Address - Phone:206-604-4620
Mailing Address - Fax:
Practice Address - Street 1:29398 RECOVERY WAY
Practice Address - Street 2:
Practice Address - City:JUNCTION CITY
Practice Address - State:OR
Practice Address - Zip Code:97448-8447
Practice Address - Country:US
Practice Address - Phone:541-465-2554
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-09-03
Last Update Date:2023-10-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WARN60219986163W00000X
WAAP60588621363LP0808X
OR201507290NP-PP363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
No163W00000XNursing Service ProvidersRegistered Nurse