Provider Demographics
NPI:1225776503
Name:AUSTIN, NATHANIEL RICHARD (APRN, FNP-C)
Entity Type:Individual
Prefix:
First Name:NATHANIEL
Middle Name:RICHARD
Last Name:AUSTIN
Suffix:
Gender:M
Credentials:APRN, FNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5727 N WINTHROP AVE APT 403
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60660-4396
Mailing Address - Country:US
Mailing Address - Phone:773-250-5222
Mailing Address - Fax:773-866-8018
Practice Address - Street 1:5727 N WINTHROP AVE APT 403
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60660-4396
Practice Address - Country:US
Practice Address - Phone:872-999-0051
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-05-25
Last Update Date:2022-05-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL209.025238363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily