=====================================================
General NPI Number Information
=====================================================
NPI Number | 1841715679
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | NATHAN P. BELL
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 08/14/2017
-----------------------------------------------------
Last Update Date | 07/21/2022
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 10625 W NORTH AVE STE 102
-----------------------------------------------------
City | MILWAUKEE
-----------------------------------------------------
State | WI
-----------------------------------------------------
Zip | 53226-2315
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 414-877-5350
-----------------------------------------------------
Fax | 414-877-5360
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 10625 W NORTH AVE STE 102
-----------------------------------------------------
City | MILWAUKEE
-----------------------------------------------------
State | WI
-----------------------------------------------------
Zip | 53226-2315
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 414-877-5350
-----------------------------------------------------
Fax | 414-877-5360
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 363AM0700X
-----------------------------------------------------
Taxonomy Name | Medical Physician Assistant
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 363AS0400X
-----------------------------------------------------
Taxonomy Name | Surgical Physician Assistant
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------
Taxonomy #3
-----------------------------------------------------
Taxonomy Code | 363A00000X
-----------------------------------------------------
Taxonomy Name | Physician Assistant
-----------------------------------------------------
License Number | 4152-23
-----------------------------------------------------
License Number State | WI
-----------------------------------------------------