Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LP2300X | Nurse Practitioner - Primary Care | 101409 | OK |
NPI | 1083283329 |
---|---|
Provider Name | Mr. Nathan Veral Hollenbeck |
First Address | Oklahoma City, OK 73114-2817 |
Second Address | Oklahoma City, OK 73114-2817 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 22/06/2021 |
Last Update Date | 22/06/2021 |