Provider Demographics
NPI:1073949111
Name:VOTROUBEK, NATHAN DANIEL
Entity Type:Individual
Prefix:
First Name:NATHAN
Middle Name:DANIEL
Last Name:VOTROUBEK
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7514 TREE LN APT 2
Mailing Address - Street 2:
Mailing Address - City:MADISON
Mailing Address - State:WI
Mailing Address - Zip Code:53717-1691
Mailing Address - Country:US
Mailing Address - Phone:319-551-4921
Mailing Address - Fax:
Practice Address - Street 1:7514 TREE LN APT 2
Practice Address - Street 2:
Practice Address - City:MADISON
Practice Address - State:WI
Practice Address - Zip Code:53717-1691
Practice Address - Country:US
Practice Address - Phone:319-551-4921
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-09-20
Last Update Date:2013-09-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI17274-40183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist