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General NPI Number Information
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NPI Number | 1285299495
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Entity Type | Individual
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Provider Name | NATHANIEL PAUL JR.
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Gender | Male
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Dates
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Enumeration Date | 05/02/2019
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Last Update Date | 05/02/2019
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Provider Practice Location Address
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Address Line | 18109 MARX ST
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City | DETROIT
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State | MI
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Zip | 48203-5401
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Country | US
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Telephone | 313-854-9164
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Fax |
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Provider Business Mailing Address
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Address Line | 18109 MARX ST
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City | DETROIT
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State | MI
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Zip | 48203-5401
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Country | US
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Telephone | 313-854-9164
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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 | 164X00000X
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Taxonomy Name | Licensed Vocational Nurse
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License Number | 4703119292
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License Number State | MI
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