Provider Demographics
NPI:1497271175
Name:RAINWATER, NATHAN PHILIP
Entity Type:Individual
Prefix:
First Name:NATHAN
Middle Name:PHILIP
Last Name:RAINWATER
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 1:115 BROADWAY STE 1800
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10006-1652
Mailing Address - Country:US
Mailing Address - Phone:212-858-9199
Mailing Address - Fax:212-858-9148
Practice Address - Street 1:115 BROADWAY STE 1800
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10006
Practice Address - Country:US
Practice Address - Phone:212-858-9199
Practice Address - Fax:212-858-9148
Is Sole Proprietor?:No
Enumeration Date:2017-08-15
Last Update Date:2019-05-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN173978163WG0000X
NY736219163WG0000X
NY402312363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
No163WG0000XNursing Service ProvidersRegistered NurseGeneral Practice