Healthcare Provider Details

I. General information

NPI: 1649009424
Provider Name (Legal Business Name): NATHANIEL ADAM BEUTLER AUD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/30/2024
Last Update Date: 07/30/2024
Certification Date: 07/30/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9425 SANDIFUR PKWY STE 103
PASCO WA
99301-8083
US

IV. Provider business mailing address

9425 SANDIFUR PKWY STE 103
PASCO WA
99301-8083
US

V. Phone/Fax

Practice location:
  • Phone: 509-492-4951
  • Fax:
Mailing address:
  • Phone: 509-492-4951
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code231H00000X
TaxonomyAudiologist
License NumberLD61580047
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: