Provider Demographics
NPI:1588296172
Name:WILLS, NATASHA ANN (ARNP)
Entity type:Individual
Prefix:MRS
First Name:NATASHA
Middle Name:ANN
Last Name:WILLS
Suffix:
Gender:F
Credentials:ARNP
Other - Prefix:MS
Other - First Name:NATASHA
Other - Middle Name:ANN
Other - Last Name:WILLS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RN
Mailing Address - Street 1:1700 NW GILMAN BLVD STE 205
Mailing Address - Street 2:
Mailing Address - City:ISSAQUAH
Mailing Address - State:WA
Mailing Address - Zip Code:98027-5364
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1700 NW GILMAN BLVD STE 205
Practice Address - Street 2:
Practice Address - City:ISSAQUAH
Practice Address - State:WA
Practice Address - Zip Code:98027-5364
Practice Address - Country:US
Practice Address - Phone:206-636-1086
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-02-11
Last Update Date:2020-05-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WARN60086576163WN0002X
WAAP61061808363LP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics
No163WN0002XNursing Service ProvidersRegistered NurseNeonatal Intensive Care