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General NPI Number Information
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NPI Number | 1063140556
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Entity Type | Individual
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Provider Name | NATHAN KING
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Gender | Male
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Dates
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Enumeration Date | 08/11/2022
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Last Update Date | 08/11/2022
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Provider Practice Location Address
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Address Line | E7475 RAWHIDE RD
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City | NEW LONDON
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State | WI
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Zip | 54961-9025
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Country | US
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Telephone | 920-981-6100
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Fax |
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Provider Business Mailing Address
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Address Line | W6577 E MIDWAY RD APT 61
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City | APPLETON
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State | WI
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Zip | 54915-4861
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Country | US
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Telephone | 920-540-1596
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 104100000X
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Taxonomy Name | Social Worker
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License Number | 132731-121
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License Number State | WI
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