Provider Demographics
NPI:1346833704
Name:LI, NATALIE (PMHNP)
Entity type:Individual
Prefix:
First Name:NATALIE
Middle Name:
Last Name:LI
Suffix:
Gender:F
Credentials:PMHNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:98120 QUEENS BLVD APT 5E
Mailing Address - Street 2:
Mailing Address - City:REGO PARK
Mailing Address - State:NY
Mailing Address - Zip Code:11374-4340
Mailing Address - Country:US
Mailing Address - Phone:347-977-2909
Mailing Address - Fax:
Practice Address - Street 1:98120 QUEENS BLVD APT 5E
Practice Address - Street 2:
Practice Address - City:REGO PARK
Practice Address - State:NY
Practice Address - Zip Code:11374-4340
Practice Address - Country:US
Practice Address - Phone:347-977-2909
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-02-17
Last Update Date:2021-02-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY403415363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental HealthGroup - Single Specialty