Healthcare Provider Details

I. General information

NPI: 1023941218
Provider Name (Legal Business Name): NATHAN ANDREW NAZARENO
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/05/2026
Last Update Date: 06/05/2026
Certification Date: 06/05/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1 HOSPITAL DR
COLUMBIA MO
65212-1000
US

IV. Provider business mailing address

5 HOSPITAL DR # CE507
COLUMBIA MO
65201-5276
US

V. Phone/Fax

Practice location:
  • Phone: 573-882-4141
  • Fax:
Mailing address:
  • Phone: 573-882-8668
  • Fax: 573-884-4249

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084N0400X
TaxonomyNeurology Physician
License Number2026024900
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: