Healthcare Provider Details

I. General information

NPI: 1700612728
Provider Name (Legal Business Name): NATHAN PIERCE DNAP
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/09/2024
Last Update Date: 09/10/2024
Certification Date: 09/10/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9155 SW BARNES RD
PORTLAND OR
97225-6625
US

IV. Provider business mailing address

1498 PACIFIC AVE STE 500
TACOMA WA
98402-4210
US

V. Phone/Fax

Practice location:
  • Phone: 503-216-1234
  • Fax:
Mailing address:
  • Phone: 855-768-6363
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License Number151710
License Number StateOR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: