Provider Demographics
NPI:1407683998
Name:VASU, NATALIE THERESA
Entity type:Individual
Prefix:
First Name:NATALIE
Middle Name:THERESA
Last Name:VASU
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 1:5102 WILLIAMSBURG DR
Mailing Address - Street 2:
Mailing Address - City:LORAIN
Mailing Address - State:OH
Mailing Address - Zip Code:44053-3237
Mailing Address - Country:US
Mailing Address - Phone:440-787-7220
Mailing Address - Fax:
Practice Address - Street 1:5102 WILLIAMSBURG DR
Practice Address - Street 2:
Practice Address - City:LORAIN
Practice Address - State:OH
Practice Address - Zip Code:44053-3237
Practice Address - Country:US
Practice Address - Phone:440-787-7220
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-09-18
Last Update Date:2024-09-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant