Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LP0200X | Nurse Practitioner - Pediatrics | 5830 | MN |
N | 363LP0200X | Nurse Practitioner - Pediatrics | 7140 | WI |
NPI | 1043666530 |
---|---|
Provider Name | Nathan Neis |
First Address | Milwaukee, WI 53226-4874 |
Second Address | Minneapolis, MN 55404 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 13/05/2016 |
Last Update Date | 07/06/2018 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
1043666530 | (05) | WI |