Provider Demographics
NPI:1568253235
Name:BACZUK, NATALIE
Entity type:Individual
Prefix:
First Name:NATALIE
Middle Name:
Last Name:BACZUK
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 1:11665 S CLEAR BERRY CIR
Mailing Address - Street 2:
Mailing Address - City:DRAPER
Mailing Address - State:UT
Mailing Address - Zip Code:84020-6828
Mailing Address - Country:US
Mailing Address - Phone:801-971-5897
Mailing Address - Fax:
Practice Address - Street 1:11665 S CLEAR BERRY CIR
Practice Address - Street 2:
Practice Address - City:DRAPER
Practice Address - State:UT
Practice Address - Zip Code:84020-6828
Practice Address - Country:US
Practice Address - Phone:801-971-5897
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-05-13
Last Update Date:2025-05-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT103928443102163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse