Healthcare Provider Details

I. General information

NPI: 1679482186
Provider Name (Legal Business Name): NATHAN WINSOR
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/02/2026
Last Update Date: 09/02/2026
Certification Date: 09/02/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

600 RICHARD GORDON HATCHER BLVD
GARY IN
46402-6001
US

IV. Provider business mailing address

2106 MORTHLAND DR # 1098
VALPARAISO IN
46383-5914
US

V. Phone/Fax

Practice location:
  • Phone: 219-232-6229
  • Fax:
Mailing address:
  • Phone: 219-232-6229
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code246ZE0600X
TaxonomyElectroneurodiagnostic Specialist/Technologist
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: