MEDICARE: DR. NATHANIEL MICHAEL APATOV CRNA

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	163W00000X	Registered Nurse	RN-54599	HI
2	367500000X	Certified Registered Nurse Anesthetist	0024164170	VA

General Provider Information

NPI Number	:	1265411706
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. NATHANIEL MICHAEL APATOV CRNA

Provider Business Mailing Address
First Line	:	816 INDEPENDENCE BLVD
Second Line	:	STE 2G
City	:	VIRGINIA BEACH
State	:	VA
Zip	:	23455-6010
Country	:	US
Telephone Number	:	757-363-6728
Fax Number	:	757-363-6204

Provider Business Practice Location Address
First Line	:	816 INDEPENDENCE BLVD
Second Line	:	STE 2G
City	:	VIRGINIA BEACH
State	:	VA
Zip	:	23455-6010
Country	:	US
Telephone Number	:	757-363-6728
Fax Number	:	757-363-6204

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	01/12/2006
Last Update Date	:	09/28/2011

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