MEDICARE: NATHANIEL LAWRENCE WITHEROW

Medicare Provider Information

Scope of Practice

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

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	175T00000X	Peer Specialist

General Provider Information

NPI Number	:	1174486880
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	NATHANIEL LAWRENCE WITHEROW

Provider Business Mailing Address
First Line	:	164 S STATE ST APT 411
Second Line	:
City	:	SPOKANE
State	:	WA
Zip	:	99201-5137
Country	:	US
Telephone Number	:	509-475-0249
Fax Number	:

Provider Business Practice Location Address
First Line	:	164 S STATE ST APT 411
Second Line	:
City	:	SPOKANE
State	:	WA
Zip	:	99201-5137
Country	:	US
Telephone Number	:	509-475-0249
Fax Number	:

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

Provider Enumeration Date	:	12/09/2025
Last Update Date	:	12/09/2025

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