Healthcare Provider Details

I. General information

NPI: 1699162149
Provider Name (Legal Business Name): NATHAN SCHANDEVEL M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/22/2015
Last Update Date: 11/22/2024
Certification Date: 11/22/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3201 SPRINGHILL DR STE 300
NORTH LITTLE ROCK AR
72117-2909
US

IV. Provider business mailing address

212 MAIN ST
MINNEOLA KS
67865-8511
US

V. Phone/Fax

Practice location:
  • Phone: 501-753-4132
  • Fax: 501-753-4176
Mailing address:
  • Phone: 620-885-4202
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberE-17773
License Number StateAR
# 2
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number04-41285
License Number StateKS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: