Healthcare Provider Details

I. General information

NPI: 1992558282
Provider Name (Legal Business Name): NATHAN MCHAN
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/08/2024
Last Update Date: 06/09/2026
Certification Date: 06/09/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

165 E PARK AVE
NILES OH
44446-2352
US

IV. Provider business mailing address

754 WILLARD AVE SE
WARREN OH
44484-4430
US

V. Phone/Fax

Practice location:
  • Phone: 330-544-8005
  • Fax: 330-544-9379
Mailing address:
  • Phone: 330-442-0557
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License NumberS.2613990
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: