Provider Demographics
NPI:1417469982
Name:KLEIN, NATHAN JOSEPH (FNP-C)
Entity Type:Individual
Prefix:
First Name:NATHAN
Middle Name:JOSEPH
Last Name:KLEIN
Suffix:
Gender:M
Credentials:FNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15207 W PEAKVIEW RD
Mailing Address - Street 2:
Mailing Address - City:SURPRISE
Mailing Address - State:AZ
Mailing Address - Zip Code:85387-6380
Mailing Address - Country:US
Mailing Address - Phone:866-433-7666
Mailing Address - Fax:866-252-4669
Practice Address - Street 1:16515 S 40TH ST STE 143
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85048-0560
Practice Address - Country:US
Practice Address - Phone:866-433-7666
Practice Address - Fax:866-252-4669
Is Sole Proprietor?:No
Enumeration Date:2017-10-24
Last Update Date:2024-04-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZAP10605363LF0000X, 207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatology
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily