Basic Information
Provider Information
NPI: 1427507086
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: PAUL
FirstName: NATALIE
MiddleName:  
NamePrefix: MS.
NameSuffix:  
Credential: FNP
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: 1455 NW IRVING ST STE 600
Address2:  
City: PORTLAND
State: OR
PostalCode: 972092277
CountryCode: US
TelephoneNumber: 5036848252
FaxNumber: 8668598195
Practice Location
Address1: 172 NE MARTIN LUTHER KING JR BLVD
Address2:  
City: PORTLAND
State: OR
PostalCode: 972322943
CountryCode: US
TelephoneNumber: 5036848252
FaxNumber: 8668598195
Other Information
ProviderEnumerationDate: 09/23/2016
LastUpdateDate: 07/17/2020
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: F
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: N
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate: 07/17/2020

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
363LF0000X21781TNN Physician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
363LF0000XAP60701533WAN Physician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
363LF0000X202003535NP-PPORY Physician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily

No ID Information.


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