Provider Demographics
NPI:1497266712
Name:AVERY, NATHAN YOUNG (NP)
Entity Type:Individual
Prefix:
First Name:NATHAN
Middle Name:YOUNG
Last Name:AVERY
Suffix:
Gender:M
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6458 SPRUCE ST
Mailing Address - Street 2:
Mailing Address - City:TWIN LAKE
Mailing Address - State:MI
Mailing Address - Zip Code:49457-8852
Mailing Address - Country:US
Mailing Address - Phone:231-670-5633
Mailing Address - Fax:
Practice Address - Street 1:700 N SPRING ST
Practice Address - Street 2:
Practice Address - City:CALIENTE
Practice Address - State:NV
Practice Address - Zip Code:89008
Practice Address - Country:US
Practice Address - Phone:775-726-3171
Practice Address - Fax:775-726-3797
Is Sole Proprietor?:No
Enumeration Date:2017-10-13
Last Update Date:2020-01-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4704251033363L00000X
NVAPRN002938363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner