MEDICARE: NATHANIAL R ANDERSON

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	363A00000X	Physician Assistant	53324	CA

General Provider Information

NPI Number	:	1376731570
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	NATHANIAL R ANDERSON

Provider Business Mailing Address
First Line	:	PO BOX 228
Second Line	:
City	:	ROUND MOUNTAIN
State	:	CA
Zip	:	96084-0228
Country	:	US
Telephone Number	:	530-337-5750
Fax Number	:

Provider Business Practice Location Address
First Line	:	29632 HWY 299E
Second Line	:
City	:	ROUND MOUNTAIN
State	:	CA
Zip	:	96084
Country	:	US
Telephone Number	:	530-337-5750
Fax Number	:

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

Provider Enumeration Date	:	10/12/2007
Last Update Date	:	04/26/2016

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Directions to “ NATHANIAL R ANDERSON ” Practice Location

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