Healthcare Provider Details

I. General information

NPI: 1811533987
Provider Name (Legal Business Name): NATHAN IRWIN SCHLEIFER
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/22/2019
Last Update Date: 11/22/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

36065 SANTA FE AVE
FORT HOOD TX
76544-5060
US

IV. Provider business mailing address

905 SARATOGA LN
COPPERAS COVE TX
76522-4738
US

V. Phone/Fax

Practice location:
  • Phone: 254-553-9847
  • Fax:
Mailing address:
  • Phone: 360-509-2286
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WE0003X
TaxonomyEmergency Registered Nurse
License NumberRN60100953
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: