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General NPI Number Information
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NPI Number | 1255243085
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Entity Type | Individual
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Provider Name | NATHAN WALLER
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Gender | Male
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Dates
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Enumeration Date | 09/17/2026
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Last Update Date | 09/17/2026
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Provider Practice Location Address
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Address Line | 1511 POLY DR
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City | BILLINGS
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State | MT
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Zip | 59102-1739
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Country | US
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Telephone | 406-657-1190
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Fax |
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Provider Business Mailing Address
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Address Line | 1012 HILLSIDE CIR
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City | VERONA
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State | WI
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Zip | 53593-8375
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Country | US
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Telephone |
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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 | 363A00000X
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Taxonomy Name | Physician Assistant
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License Number | 1247861
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License Number State | WI
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