Healthcare Provider Details

I. General information

NPI: 1215671573
Provider Name (Legal Business Name): NATHANIEL BIGOT
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/22/2022
Last Update Date: 07/12/2024
Certification Date: 06/19/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

200 MULLINS DR
LEBANON OR
97355-3983
US

IV. Provider business mailing address

3550 TERRACE STREET A711 SCAIFE HALL
PITTSBURGH PA
15261-0001
US

V. Phone/Fax

Practice location:
  • Phone: 541-259-0235
  • Fax:
Mailing address:
  • Phone: 412-802-6013
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: