Provider Demographics
NPI:1104399070
Name:PILGREEN, NATTYA S
Entity type:Individual
Prefix:
First Name:NATTYA
Middle Name:S
Last Name:PILGREEN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10321 BUNCLODY DR
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28213-0217
Mailing Address - Country:US
Mailing Address - Phone:252-258-6399
Mailing Address - Fax:
Practice Address - Street 1:10216 PERIMETER PKWY STE A
Practice Address - Street 2:
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28216-2462
Practice Address - Country:US
Practice Address - Phone:252-258-6399
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-01-03
Last Update Date:2022-11-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCC98508224P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224P00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersProsthetist