Provider Demographics
NPI:1033709159
Name:CLABAUGH, NATHAN (RP)
Entity Type:Individual
Prefix:DR
First Name:NATHAN
Middle Name:
Last Name:CLABAUGH
Suffix:
Gender:M
Credentials:RP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:501 COURT ST
Mailing Address - Street 2:
Mailing Address - City:BEATRICE
Mailing Address - State:NE
Mailing Address - Zip Code:68310-3989
Mailing Address - Country:US
Mailing Address - Phone:402-223-3591
Mailing Address - Fax:
Practice Address - Street 1:501 COURT ST
Practice Address - Street 2:
Practice Address - City:BEATRICE
Practice Address - State:NE
Practice Address - Zip Code:68310-3989
Practice Address - Country:US
Practice Address - Phone:402-223-3591
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-01-22
Last Update Date:2021-01-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE12228183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist