1891778262 NPI number — MRS. NATALIA GOETZ HERTZ BCFNP

Table of content: COURTNEY E CAPELLA MD (NPI 1255998704)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1891778262 NPI number — MRS. NATALIA GOETZ HERTZ BCFNP

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
HERTZ
Provider First Name:
NATALIA
Provider Middle Name:
GOETZ
Provider Name Prefix Text:
MRS.
Provider Name Suffix Text:
Provider Credential Text:
BCFNP
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
GOETZ
Provider Other First Name:
NATALIA
Provider Other Middle Name:
Provider Other Name Prefix Text:
MS.
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1891778262
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
04/26/2021
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
6035 FAIRVIEW RD
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
CHARLOTTE
Provider Business Mailing Address State Name:
NC
Provider Business Mailing Address Postal Code:
28210-3256
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
704-295-3000
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
724 AUBREY BELL DR
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
MATTHEWS
Provider Business Practice Location Address State Name:
NC
Provider Business Practice Location Address Postal Code:
28105-5055
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
704-295-3550
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
11/21/2005

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 363LF0000X , with the licence number:  0024166742 , registered in the state of VA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 363LF0000X , with the licence number: 0050-03620 , registered in the state of NC ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: P01309686 . This is a "MEDICARE RAILROAD" identifier , issued by the state of ( NC ) . This identifiers is of the category "OTHER".
  • Identifier: 30159536 . This is a "SELECT HEALTH" identifier , issued by the state of ( SC ) . This identifiers is of the category "OTHER".
  • Identifier: 7005152 , issued by the state of ( NC ) . This identifiers is of the category "MEDICAID".
  • Identifier: 1046727 . This is a "WELLCARE OF SC" identifier , issued by the state of ( SC ) . This identifiers is of the category "OTHER".
  • Identifier: 7364986 . This is a "AETNA" identifier . This identifiers is of the category "OTHER".
  • Identifier: 17812 . This is a "BCBSNC" identifier , issued by the state of ( NC ) . This identifiers is of the category "OTHER".
  • Identifier: NP1396 , issued by the state of ( SC ) . This identifiers is of the category "MEDICAID".




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