Healthcare Provider Details

I. General information

NPI: 1750892261
Provider Name (Legal Business Name): NATHANIEL SCHWAB PA-C
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/24/2017
Last Update Date: 04/02/2025
Certification Date: 04/02/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2200 NE NEFF RD STE 200
BEND OR
97701-4281
US

IV. Provider business mailing address

2200 NE NEFF RD STE 200
BEND OR
97701-4281
US

V. Phone/Fax

Practice location:
  • Phone: 541-382-3344
  • Fax:
Mailing address:
  • Phone: 541-382-3344
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number
License Number State

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

# 1
Identifier185716
Identifier TypeOTHER
Identifier StateOR
Identifier IssuerOREGON MEDICAL BOARD
# 2
Identifier500787083
Identifier TypeMEDICAID
Identifier StateOR
Identifier Issuer

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: