Provider Demographics
NPI:1114602687
Name:SANSING, NATHAN EARL (MBA)
Entity Type:Individual
Prefix:MR
First Name:NATHAN
Middle Name:EARL
Last Name:SANSING
Suffix:
Gender:M
Credentials:MBA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:29679 JASON MALBIS BLVD
Mailing Address - Street 2:
Mailing Address - City:DAPHNE
Mailing Address - State:AL
Mailing Address - Zip Code:36526-9539
Mailing Address - Country:US
Mailing Address - Phone:251-322-9718
Mailing Address - Fax:
Practice Address - Street 1:29679 JASON MALBIS BLVD
Practice Address - Street 2:
Practice Address - City:DAPHNE
Practice Address - State:AL
Practice Address - Zip Code:36526-9539
Practice Address - Country:US
Practice Address - Phone:251-322-9718
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-06-21
Last Update Date:2023-06-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL5797922172A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172A00000XOther Service ProvidersDriver