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General NPI Number Information
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NPI Number | 1326654971
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Entity Type | Individual
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Provider Name | NATHAN NAMANNY
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Gender | Male
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Dates
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Enumeration Date | 09/18/2020
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Last Update Date | 12/23/2024
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Provider Practice Location Address
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Address Line | 3512 S LAFOUNTAIN ST
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City | KOKOMO
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State | IN
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Zip | 46902-3803
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Country | US
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Telephone | 765-776-3100
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Fax |
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Provider Business Mailing Address
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Address Line | 6626 E 75TH ST STE 500
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City | INDIANAPOLIS
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State | IN
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Zip | 46250-2890
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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 | 213ES0103X
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Taxonomy Name | Foot & Ankle Surgery Podiatrist
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License Number | 07001461A
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License Number State | IN
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Taxonomy #2
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Taxonomy Code | 390200000X
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Taxonomy Name | Student in an Organized Health Care Education/Training Program
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 213E00000X
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Taxonomy Name | Podiatrist
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License Number | 07001461A
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License Number State | IN
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