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General NPI Number Information
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NPI Number | 1295239739
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Entity Type | Individual
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Provider Name | NATHANIEL J ANDERSON
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Gender | Male
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Dates
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Enumeration Date | 03/20/2018
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Last Update Date | 03/20/2018
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Provider Practice Location Address
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Address Line | 504 E MUSSER ST
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City | CARSON CITY
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State | NV
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Zip | 89701-4239
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Country | US
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Telephone | 775-434-7422
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Fax |
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Provider Business Mailing Address
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Address Line | 1253 SORENSEN LN
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City | GARDNERVILLE
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State | NV
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Zip | 89460-8645
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Country | US
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Telephone | 775-501-7316
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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 | 225400000X
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Taxonomy Name | Rehabilitation Practitioner
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License Number |
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License Number State |
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