Provider Demographics
NPI:1629005608
Name:HORN, NATHAN
Entity Type:Individual
Prefix:MR
First Name:NATHAN
Middle Name:
Last Name:HORN
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 1:140 BUTTERNUT LN
Mailing Address - Street 2:
Mailing Address - City:EAST FAIRFIELD
Mailing Address - State:VT
Mailing Address - Zip Code:05448-4438
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:111 COLCHESTER AVE
Practice Address - Street 2:
Practice Address - City:BURLINGTON
Practice Address - State:VT
Practice Address - Zip Code:05401-1473
Practice Address - Country:US
Practice Address - Phone:802-847-2727
Practice Address - Fax:802-847-4817
Is Sole Proprietor?:No
Enumeration Date:2006-06-27
Last Update Date:2013-09-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VT135-0000013367H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367H00000XPhysician Assistants & Advanced Practice Nursing ProvidersAnesthesiologist Assistant