Healthcare Provider Details

I. General information

NPI: 1164138319
Provider Name (Legal Business Name): NATHAMY LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/30/2023
Last Update Date: 11/09/2023
Certification Date: 11/09/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

15207 W PEAKVIEW RD
SURPRISE AZ
85387-6380
US

IV. Provider business mailing address

15207 W PEAKVIEW RD
SURPRISE AZ
85387-6380
US

V. Phone/Fax

Practice location:
  • Phone: 602-348-8917
  • Fax:
Mailing address:
  • Phone: 602-348-8917
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207N00000X
TaxonomyDermatology Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number
License Number State

VIII. Authorized Official

Name: NATHAN JOSEPH KLEIN
Title or Position: FOUNDER - NURSE PRACTITIONER
Credential: NP-C
Phone: 602-348-8917