Provider Demographics
NPI:1104594704
Name:COLE, NATALIE ALEXIS (RN)
Entity type:Individual
Prefix:
First Name:NATALIE
Middle Name:ALEXIS
Last Name:COLE
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:595 W MAIN ST
Mailing Address - Street 2:
Mailing Address - City:WATERTOWN
Mailing Address - State:NY
Mailing Address - Zip Code:13601-1381
Mailing Address - Country:US
Mailing Address - Phone:315-788-1530
Mailing Address - Fax:315-788-3794
Practice Address - Street 1:1130 STATE ST
Practice Address - Street 2:
Practice Address - City:WATERTOWN
Practice Address - State:NY
Practice Address - Zip Code:13601-3549
Practice Address - Country:US
Practice Address - Phone:315-779-1772
Practice Address - Fax:315-782-0609
Is Sole Proprietor?:No
Enumeration Date:2021-08-31
Last Update Date:2021-08-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY793659163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse