Healthcare Provider Details

I. General information

NPI: 1336796739
Provider Name (Legal Business Name): NATHAN J BATES PA-C
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/20/2019
Last Update Date: 08/25/2023
Certification Date: 08/25/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1310 1ST ST S
WILLMAR MN
56201-4242
US

IV. Provider business mailing address

3699 45TH AVE SW
WILLMAR MN
56201-9719
US

V. Phone/Fax

Practice location:
  • Phone: 320-235-6506
  • Fax:
Mailing address:
  • Phone: 218-686-3747
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363AS0400X
TaxonomySurgical Physician Assistant
License Number14491
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: