Healthcare Provider Details

I. General information

NPI: 1134024110
Provider Name (Legal Business Name): NATHANIEL JAMES CHINN
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/10/2026
Last Update Date: 10/10/2026
Certification Date: 10/10/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1135 TERMINAL WAY STE 208
RENO NV
89502-2168
US

IV. Provider business mailing address

695 W 3RD ST APT 255
RENO NV
89503-5248
US

V. Phone/Fax

Practice location:
  • Phone: 775-322-3668
  • Fax:
Mailing address:
  • Phone: 916-217-9633
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License Number13231-M
License Number StateNV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: