Provider Demographics
NPI:1154437796
Name:KEILHOLZ, NATALIE JEAN (ARNP)
Entity type:Individual
Prefix:
First Name:NATALIE
Middle Name:JEAN
Last Name:KEILHOLZ
Suffix:
Gender:F
Credentials:ARNP
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 34888
Mailing Address - Street 2:
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98124-1888
Mailing Address - Country:US
Mailing Address - Phone:425-977-4620
Mailing Address - Fax:425-745-9836
Practice Address - Street 1:501 N 34TH ST
Practice Address - Street 2:SUITE 101
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98103-8856
Practice Address - Country:US
Practice Address - Phone:206-838-1777
Practice Address - Fax:206-838-1771
Is Sole Proprietor?:No
Enumeration Date:2006-08-23
Last Update Date:2014-03-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAAP30007161363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA0212662OtherLABOR AND INDUSTRIES
WA1003740Medicaid
WA0212662OtherLABOR AND INDUSTRIES