Healthcare Provider Details

I. General information

NPI: 1174990238
Provider Name (Legal Business Name): NATHAN ANDERSON
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/25/2015
Last Update Date: 08/25/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7475 MINERAL POINT RD STE 15
MADISON WI
53717-1720
US

IV. Provider business mailing address

7475 MINERAL POINT RD STE 15
MADISON WI
53717-1720
US

V. Phone/Fax

Practice location:
  • Phone: 608-821-0075
  • Fax:
Mailing address:
  • Phone: 608-821-0075
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code237700000X
TaxonomyHearing Instrument Specialist
License Number1470-60
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: