Provider Demographics
NPI:1235757220
Name:DANNEKER, NATHAN FORREST
Entity Type:Individual
Prefix:
First Name:NATHAN
Middle Name:FORREST
Last Name:DANNEKER
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 1:149 PLANTATION RIDGE DR STE 190
Mailing Address - Street 2:
Mailing Address - City:MOORESVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28117-9178
Mailing Address - Country:US
Mailing Address - Phone:704-658-0595
Mailing Address - Fax:704-658-0916
Practice Address - Street 1:149 PLANTATION RIDGE DR STE 190
Practice Address - Street 2:
Practice Address - City:MOORESVILLE
Practice Address - State:NC
Practice Address - Zip Code:28117-9178
Practice Address - Country:US
Practice Address - Phone:704-658-0595
Practice Address - Fax:704-658-0916
Is Sole Proprietor?:No
Enumeration Date:2020-07-07
Last Update Date:2021-04-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC231H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologist