Provider Demographics
NPI:1578102661
Name:NEVIUS, NATHAN D (BS, LMT)
Entity Type:Individual
Prefix:MR
First Name:NATHAN
Middle Name:D
Last Name:NEVIUS
Suffix:
Gender:M
Credentials:BS, LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1357 MONACO DR
Mailing Address - Street 2:
Mailing Address - City:SEVERN
Mailing Address - State:MD
Mailing Address - Zip Code:21144-2726
Mailing Address - Country:US
Mailing Address - Phone:443-454-0046
Mailing Address - Fax:
Practice Address - Street 1:1357 MONACO DR
Practice Address - Street 2:
Practice Address - City:SEVERN
Practice Address - State:MD
Practice Address - Zip Code:21144-2726
Practice Address - Country:US
Practice Address - Phone:443-454-0046
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-01-06
Last Update Date:2020-01-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDM05009225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist