Healthcare Provider Details

I. General information

NPI: 1225776503
Provider Name (Legal Business Name): NATHANIEL RICHARD AUSTIN APRN, FNP-C
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/25/2022
Last Update Date: 05/30/2026
Certification Date: 05/30/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5727 N WINTHROP AVE APT 403
CHICAGO IL
60660-4396
US

IV. Provider business mailing address

5727 N WINTHROP AVE APT 403
CHICAGO IL
60660-4396
US

V. Phone/Fax

Practice location:
  • Phone: 872-999-0051
  • Fax:
Mailing address:
  • Phone: 773-250-5222
  • Fax: 773-866-8018

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number209.025238
License Number StateIL
# 2
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number209.025238
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: