Provider Demographics
NPI:1871162545
Name:THOMAS, NATALIE CHANTEL (RN)
Entity type:Individual
Prefix:MISS
First Name:NATALIE
Middle Name:CHANTEL
Last Name:THOMAS
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:NATALIE
Other - Middle Name:CHANTEL
Other - Last Name:BROADIE
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:109 CLAREMONT AVE FL 3
Mailing Address - Street 2:
Mailing Address - City:JERSEY CITY
Mailing Address - State:NJ
Mailing Address - Zip Code:07305-3605
Mailing Address - Country:US
Mailing Address - Phone:551-247-1639
Mailing Address - Fax:
Practice Address - Street 1:109 CLAREMONT AVE FL 3
Practice Address - Street 2:
Practice Address - City:JERSEY CITY
Practice Address - State:NJ
Practice Address - Zip Code:07305-3605
Practice Address - Country:US
Practice Address - Phone:551-247-1639
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-06-17
Last Update Date:2021-06-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ26NR20334900163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse