Provider Demographics
NPI:1063024354
Name:RAIDEL, NATHANIEL Z (FNP)
Entity Type:Individual
Prefix:
First Name:NATHANIEL
Middle Name:Z
Last Name:RAIDEL
Suffix:
Gender:M
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5699 SANDALWOOD BLVD
Mailing Address - Street 2:
Mailing Address - City:COLUMBUS
Mailing Address - State:OH
Mailing Address - Zip Code:43229-3420
Mailing Address - Country:US
Mailing Address - Phone:614-531-0769
Mailing Address - Fax:
Practice Address - Street 1:1885 HENDERSON RD
Practice Address - Street 2:
Practice Address - City:UPPER ARLINGTON
Practice Address - State:OH
Practice Address - Zip Code:43220-2501
Practice Address - Country:US
Practice Address - Phone:614-451-6555
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-08-19
Last Update Date:2023-07-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHF01200982363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily