Provider Demographics
NPI:1639556475
Name:FELL, NATHAN GRAHAM (CRNA, DMPNA)
Entity Type:Individual
Prefix:
First Name:NATHAN
Middle Name:GRAHAM
Last Name:FELL
Suffix:
Gender:M
Credentials:CRNA, DMPNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:62 SUTPHIN LN
Mailing Address - Street 2:
Mailing Address - City:SCARBRO
Mailing Address - State:WV
Mailing Address - Zip Code:25917-9800
Mailing Address - Country:US
Mailing Address - Phone:304-685-0008
Mailing Address - Fax:
Practice Address - Street 1:306 STANAFORD RD.
Practice Address - Street 2:BECKLEY ARH
Practice Address - City:BECKLEY
Practice Address - State:WV
Practice Address - Zip Code:25801
Practice Address - Country:US
Practice Address - Phone:304-255-3000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-04-30
Last Update Date:2015-04-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV78707367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered