Provider Demographics
NPI:1629429451
Name:SHUMWAY, NATHAN CHARLES (DPM)
Entity Type:Individual
Prefix:DR
First Name:NATHAN
Middle Name:CHARLES
Last Name:SHUMWAY
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:320 MCKENZIE AVE STE 102
Mailing Address - Street 2:
Mailing Address - City:COUNCIL BLUFFS
Mailing Address - State:IA
Mailing Address - Zip Code:51503-1002
Mailing Address - Country:US
Mailing Address - Phone:712-328-0297
Mailing Address - Fax:712-328-2403
Practice Address - Street 1:320 MCKENZIE AVE STE 102
Practice Address - Street 2:
Practice Address - City:COUNCIL BLUFFS
Practice Address - State:IA
Practice Address - Zip Code:51503
Practice Address - Country:US
Practice Address - Phone:712-328-0297
Practice Address - Fax:712-328-2403
Is Sole Proprietor?:No
Enumeration Date:2016-06-22
Last Update Date:2019-06-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COPDT-559213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle Surgery