Healthcare Provider Details

I. General information

NPI: 1508503087
Provider Name (Legal Business Name): NATHAN ALBERT WIGTON BELL PA-C
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/17/2022
Last Update Date: 01/31/2024
Certification Date: 01/31/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

426 INDUSTRIAL AVE STE 130
WILLISTON VT
05495-4449
US

IV. Provider business mailing address

426 INDUSTRIAL AVE STE 130
WILLISTON VT
05495-4449
US

V. Phone/Fax

Practice location:
  • Phone: 802-878-1008
  • Fax:
Mailing address:
  • Phone: 802-878-1008
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number055.0031607
License Number StateVT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: