Provider Demographics
NPI:1861012692
Name:ENRIGHT, NATALIE KAY (PA-C)
Entity type:Individual
Prefix:MRS
First Name:NATALIE
Middle Name:KAY
Last Name:ENRIGHT
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:NATALIE
Other - Middle Name:KAY
Other - Last Name:KRUPINSKI
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:248 MCHENRY ST
Mailing Address - Street 2:
Mailing Address - City:BURLINGTON
Mailing Address - State:WI
Mailing Address - Zip Code:53105-1828
Mailing Address - Country:US
Mailing Address - Phone:262-767-8000
Mailing Address - Fax:262-767-8190
Practice Address - Street 1:3400 DEERFIELD DR
Practice Address - Street 2:
Practice Address - City:JANESVILLE
Practice Address - State:WI
Practice Address - Zip Code:53546-3557
Practice Address - Country:US
Practice Address - Phone:608-314-3605
Practice Address - Fax:608-314-3605
Is Sole Proprietor?:Yes
Enumeration Date:2020-04-22
Last Update Date:2022-12-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
363AM0700X, 390200000X
WI5424-023363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
No363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedicalGroup - Single Specialty
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI100180313Medicaid