Provider Demographics
NPI:1235571936
Name:SCADLOCK, NATHAN WAYNE (DNP, ARNP)
Entity Type:Individual
Prefix:DR
First Name:NATHAN
Middle Name:WAYNE
Last Name:SCADLOCK
Suffix:
Gender:M
Credentials:DNP, ARNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 1648
Mailing Address - Street 2:
Mailing Address - City:EUGENE
Mailing Address - State:OR
Mailing Address - Zip Code:97440-1648
Mailing Address - Country:US
Mailing Address - Phone:541-687-4900
Mailing Address - Fax:541-463-2820
Practice Address - Street 1:1650 CHAMBERS ST
Practice Address - Street 2:
Practice Address - City:EUGENE
Practice Address - State:OR
Practice Address - Zip Code:97402-3636
Practice Address - Country:US
Practice Address - Phone:541-686-1711
Practice Address - Fax:541-686-6018
Is Sole Proprietor?:No
Enumeration Date:2013-07-23
Last Update Date:2019-06-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR201900807NP-PP363LP2300X
IAA121762363LP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP2300XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPrimary Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR500760659Medicaid