Basic Information
| Provider Information | |||||||||
| NPI: | 1689096257 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | WARMUTH | ||||||||
| FirstName: | NATALIE | ||||||||
| MiddleName: | ELIZABETH | ||||||||
| NamePrefix: | MRS. | ||||||||
| NameSuffix: | |||||||||
| Credential: | PA-C | ||||||||
| OtherOrganizationName: | |||||||||
| OtherOrganizationType: | |||||||||
| OtherLastName: | CHURCH | ||||||||
| OtherFirstName: | NATALIE | ||||||||
| OtherMiddleName: | ELIZABETH | ||||||||
| OtherNamePrefix: | MS. | ||||||||
| OtherNameSuffix: | |||||||||
| OtherCredential: | |||||||||
| OtherLastNameType: | 1 | ||||||||
| Mailing Information | |||||||||
| Address1: | 830 WEST DIVERSEY PKWY. | ||||||||
| Address2: | SUITE 300 | ||||||||
| City: | CHICAGO | ||||||||
| State: | IL | ||||||||
| PostalCode: | 606148711 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7732484150 | ||||||||
| FaxNumber: | 7732484291 | ||||||||
| Practice Location | |||||||||
| Address1: | 830 WEST DIVERSEY PKWY. | ||||||||
| Address2: | SUITE 300 | ||||||||
| City: | CHICAGO | ||||||||
| State: | IL | ||||||||
| PostalCode: | 606148711 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7732484150 | ||||||||
| FaxNumber: | 7732484291 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 01/15/2014 | ||||||||
| LastUpdateDate: | 05/05/2016 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363AS0400X | 085004848 | IL | Y | Physician Assistants & Advanced Practice Nursing Providers | Physician Assistant | Surgical |
No ID Information.