Provider Demographics
NPI:1356633770
Name:NITZKY, NATHAN (RNFA)
Entity Type:Individual
Prefix:MR
First Name:NATHAN
Middle Name:
Last Name:NITZKY
Suffix:
Gender:M
Credentials:RNFA
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 12401
Mailing Address - Street 2:
Mailing Address - City:TEMPE
Mailing Address - State:AZ
Mailing Address - Zip Code:85284-0041
Mailing Address - Country:US
Mailing Address - Phone:602-696-8664
Mailing Address - Fax:
Practice Address - Street 1:1012 E VINEDO LN
Practice Address - Street 2:
Practice Address - City:TEMPE
Practice Address - State:AZ
Practice Address - Zip Code:85284-1529
Practice Address - Country:US
Practice Address - Phone:602-696-8664
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-05-03
Last Update Date:2011-05-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZRN111312163WR0006X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WR0006XNursing Service ProvidersRegistered NurseRegistered Nurse First Assistant