Provider Demographics
NPI:1306078233
Name:SOVETSKY-CHABOT, NATACHA J (NP)
Entity type:Individual
Prefix:
First Name:NATACHA
Middle Name:J
Last Name:SOVETSKY-CHABOT
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10 GOODALL DR
Mailing Address - Street 2:SUITE 200
Mailing Address - City:EAST WATERBORO
Mailing Address - State:ME
Mailing Address - Zip Code:04030-5214
Mailing Address - Country:US
Mailing Address - Phone:207-490-7970
Mailing Address - Fax:204-247-6314
Practice Address - Street 1:10 GOODALL DR
Practice Address - Street 2:SUITE 200
Practice Address - City:EAST WATERBORO
Practice Address - State:ME
Practice Address - Zip Code:04030-5214
Practice Address - Country:US
Practice Address - Phone:207-490-7970
Practice Address - Fax:204-247-6314
Is Sole Proprietor?:No
Enumeration Date:2009-08-11
Last Update Date:2013-02-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MEAP091049363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
ME434893099Medicaid