MEDICARE: MR. NATHANIEL R YOUNG

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	225400000X	Rehabilitation Practitioner		NV

General Provider Information

NPI Number	:	1598108169
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. NATHANIEL R YOUNG

Provider Business Mailing Address
First Line	:	4310 CAMERON ST
Second Line	:	UNIT 11
City	:	LAS VEGAS
State	:	NV
Zip	:	89103-3826
Country	:	US
Telephone Number	:	702-570-5100
Fax Number	:	702-570-5104

Provider Business Practice Location Address
First Line	:	4310 CAMERON ST
Second Line	:	UNIT 11
City	:	LAS VEGAS
State	:	NV
Zip	:	89103-3826
Country	:	US
Telephone Number	:	702-570-5100
Fax Number	:	702-570-5104

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

Provider Enumeration Date	:	04/12/2013
Last Update Date	:	02/20/2014

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Directions to “ MR. NATHANIEL R YOUNG ” Practice Location

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