Provider Demographics
NPI:1871203471
Name:PUGH, NATASHA M (CSFA/CST)
Entity type:Individual
Prefix:
First Name:NATASHA
Middle Name:M
Last Name:PUGH
Suffix:
Gender:F
Credentials:CSFA/CST
Other - Prefix:
Other - First Name:NATASHA
Other - Middle Name:M
Other - Last Name:PUGH OFOR
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:CSFA/ CST
Mailing Address - Street 1:845 GINETTE ST
Mailing Address - Street 2:
Mailing Address - City:GRETNA
Mailing Address - State:LA
Mailing Address - Zip Code:70056-7701
Mailing Address - Country:US
Mailing Address - Phone:832-774-9496
Mailing Address - Fax:
Practice Address - Street 1:845 GINETTE ST
Practice Address - Street 2:
Practice Address - City:GRETNA
Practice Address - State:LA
Practice Address - Zip Code:70056-7701
Practice Address - Country:US
Practice Address - Phone:832-774-9496
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-12-05
Last Update Date:2022-12-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA206220246ZC0007X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes246ZC0007XTechnologists, Technicians & Other Technical Service ProvidersSpecialist/Technologist, OtherSurgical Assistant