Provider Demographics
NPI:1518748383
Name:GATES, NATHANIEL (HIS)
Entity Type:Individual
Prefix:
First Name:NATHANIEL
Middle Name:
Last Name:GATES
Suffix:
Gender:M
Credentials:HIS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:135 CROWN DR STE F
Mailing Address - Street 2:
Mailing Address - City:DANVILLE
Mailing Address - State:VA
Mailing Address - Zip Code:24540-5945
Mailing Address - Country:US
Mailing Address - Phone:434-791-3351
Mailing Address - Fax:
Practice Address - Street 1:135 CROWN DR STE F
Practice Address - Street 2:
Practice Address - City:DANVILLE
Practice Address - State:VA
Practice Address - Zip Code:24540-5945
Practice Address - Country:US
Practice Address - Phone:434-791-3351
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-10-09
Last Update Date:2023-10-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA2101002735237700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes237700000XSpeech, Language and Hearing Service ProvidersHearing Instrument Specialist