Provider Demographics
NPI:1114739539
Name:HYATT, NATASHA LATRECE
Entity type:Individual
Prefix:
First Name:NATASHA
Middle Name:LATRECE
Last Name:HYATT
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:PO BOX 25546
Mailing Address - Street 2:
Mailing Address - City:EUGENE
Mailing Address - State:OR
Mailing Address - Zip Code:97402-0457
Mailing Address - Country:US
Mailing Address - Phone:541-556-9079
Mailing Address - Fax:
Practice Address - Street 1:72A CENTENNIAL LOOP
Practice Address - Street 2:
Practice Address - City:EUGENE
Practice Address - State:OR
Practice Address - Zip Code:97401-2444
Practice Address - Country:US
Practice Address - Phone:503-363-8068
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-01-22
Last Update Date:2025-01-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORTHW000109407175T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes175T00000XOther Service ProvidersPeer Specialist