MEDICARE: NATHAN HENRY

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy
1	171W00000X	Contractor
2	372500000X	Chore Provider
3	171WH0202X	Home Modifications Contractor

General Provider Information

NPI Number	:	1073360400
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	NATHAN HENRY

Provider Business Mailing Address
First Line	:	2319 VAN BUSKIRK RD
Second Line	:
City	:	ANDERSON
State	:	IN
Zip	:	46011-1044
Country	:	US
Telephone Number	:	765-278-2959
Fax Number	:

Provider Business Practice Location Address
First Line	:	2319 VAN BUSKIRK RD
Second Line	:
City	:	ANDERSON
State	:	IN
Zip	:	46011-1044
Country	:	US
Telephone Number	:	765-278-2959
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/03/2024
Last Update Date	:	05/03/2024

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Directions to “ NATHAN HENRY ” Practice Location

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