Healthcare Provider Details

I. General information

NPI: 1508287269
Provider Name (Legal Business Name): NATHANIEL D HOMESTEAD LSW
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/26/2013
Last Update Date: 06/28/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1575 DELUCCHI LN STE 220
RENO NV
89502-8521
US

IV. Provider business mailing address

PO BOX 8553
RENO NV
89507-8553
US

V. Phone/Fax

Practice location:
  • Phone: 775-825-7500
  • Fax:
Mailing address:
  • Phone: 775-781-7894
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225C00000X
TaxonomyRehabilitation Counselor
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: