Provider Demographics
NPI:1578803110
Name:BLAND, NATHANIEL GARRETT (EMT-I)
Entity Type:Individual
Prefix:
First Name:NATHANIEL
Middle Name:GARRETT
Last Name:BLAND
Suffix:
Gender:M
Credentials:EMT-I
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:24895 SHAKE RIDGE RD
Mailing Address - Street 2:
Mailing Address - City:VOLCANO
Mailing Address - State:CA
Mailing Address - Zip Code:95689-9613
Mailing Address - Country:US
Mailing Address - Phone:209-217-1138
Mailing Address - Fax:
Practice Address - Street 1:24895 SHAKE RIDGE RD
Practice Address - Street 2:
Practice Address - City:VOLCANO
Practice Address - State:CA
Practice Address - Zip Code:95689-9613
Practice Address - Country:US
Practice Address - Phone:209-217-1138
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-02-19
Last Update Date:2013-02-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAE088308146N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes146N00000XEmergency Medical Service ProvidersEmergency Medical Technician, Basic