Basic Information
| Provider Information | |||||||||
| NPI: | 1902110216 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | SILL | ||||||||
| FirstName: | NATASHA | ||||||||
| MiddleName: | BETTINA | ||||||||
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| Credential: | CPNP | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1381 UNIVERSITY ST | ||||||||
| Address2: | |||||||||
| City: | HEALDSBURG | ||||||||
| State: | CA | ||||||||
| PostalCode: | 954483314 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7074335494 | ||||||||
| FaxNumber: | 7074318649 | ||||||||
| Practice Location | |||||||||
| Address1: | 1381 UNIVERSITY ST | ||||||||
| Address2: | |||||||||
| City: | HEALDSBURG | ||||||||
| State: | CA | ||||||||
| PostalCode: | 95448 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7074335494 | ||||||||
| FaxNumber: | 7074318649 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/28/2010 | ||||||||
| LastUpdateDate: | 05/24/2018 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363LP0200X | 19946 | CA | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Pediatrics |
No ID Information.