Provider Demographics
NPI:1407187859
Name:GAMMILL, NATHAN BRADY (RN, FNP)
Entity Type:Individual
Prefix:MR
First Name:NATHAN
Middle Name:BRADY
Last Name:GAMMILL
Suffix:
Gender:M
Credentials:RN, FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:52 SAINT NICHOLAS PL
Mailing Address - Street 2:APT.#31
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10031-1239
Mailing Address - Country:US
Mailing Address - Phone:646-275-0462
Mailing Address - Fax:
Practice Address - Street 1:52 SAINT NICHOLAS PL
Practice Address - Street 2:APT.#31
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10031-1239
Practice Address - Country:US
Practice Address - Phone:646-275-0462
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-01-25
Last Update Date:2016-09-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY606583-1163W00000X
NY336689363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No163W00000XNursing Service ProvidersRegistered Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYW01882OtherMEDICARE NUMBER