MEDICARE: NATHAN DANIEL VALE MSN, PMHNP-BC

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	363LP0808X	Psychiatric/Mental Health Nurse Practitioner	209.034683	IL
2	163W00000X	Registered Nurse	296882	NC

General Provider Information

NPI Number	:	1871472639
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	NATHAN DANIEL VALE MSN, PMHNP-BC

Provider Business Mailing Address
First Line	:	1025 W ADDISON ST APT 801
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60613-5185
Country	:	US
Telephone Number	:	919-210-5708
Fax Number	:

Provider Business Practice Location Address
First Line	:	1025 W ADDISON ST APT 801
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60613-5185
Country	:	US
Telephone Number	:	919-630-6418
Fax Number	:

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

Provider Enumeration Date	:	08/27/2025
Last Update Date	:	04/13/2026

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