Provider Demographics
NPI:1164138319
Name:NATHAMY LLC
Entity Type:Organization
Organization Name:NATHAMY LLC
Other - Org Name:DERM NOW ARIZONA
Other - Org Type:Doing Business As
Authorized Official - Title/Position:FOUNDER - NURSE PRACTITIONER
Authorized Official - Prefix:
Authorized Official - First Name:NATHAN
Authorized Official - Middle Name:JOSEPH
Authorized Official - Last Name:KLEIN
Authorized Official - Suffix:
Authorized Official - Credentials:NP-C
Authorized Official - Phone:602-348-8917
Mailing Address - Street 1:15207 W PEAKVIEW RD
Mailing Address - Street 2:
Mailing Address - City:SURPRISE
Mailing Address - State:AZ
Mailing Address - Zip Code:85387-6380
Mailing Address - Country:US
Mailing Address - Phone:602-348-8917
Mailing Address - Fax:
Practice Address - Street 1:15207 W PEAKVIEW RD
Practice Address - Street 2:
Practice Address - City:SURPRISE
Practice Address - State:AZ
Practice Address - Zip Code:85387-6380
Practice Address - Country:US
Practice Address - Phone:602-348-8917
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-01-30
Last Update Date:2023-11-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatologyGroup - Multi-Specialty
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ347256Medicaid