Healthcare Provider Details

I. General information

NPI: 1922481845
Provider Name (Legal Business Name): NATHANIEL HEYSLER
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/09/2015
Last Update Date: 07/09/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5091 MAIN ST # 7
WAITSFIELD VT
05673-7111
US

IV. Provider business mailing address

5091 MAIN ST # 7
WAITSFIELD VT
05673-7111
US

V. Phone/Fax

Practice location:
  • Phone: 802-496-2345
  • Fax: 802-496-4337
Mailing address:
  • Phone: 802-496-2345
  • Fax: 802-496-4337

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number033.0079677
License Number StateVT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: