Provider Demographics
NPI:1689027161
Name:DUELL, NATHAN GREGORY
Entity Type:Individual
Prefix:
First Name:NATHAN
Middle Name:GREGORY
Last Name:DUELL
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 1:9809 WHITECLAY CT
Mailing Address - Street 2:
Mailing Address - City:RALEIGH
Mailing Address - State:NC
Mailing Address - Zip Code:27617-7902
Mailing Address - Country:US
Mailing Address - Phone:919-407-1927
Mailing Address - Fax:
Practice Address - Street 1:9809 WHITECLAY CT
Practice Address - Street 2:
Practice Address - City:RALEIGH
Practice Address - State:NC
Practice Address - Zip Code:27617-7902
Practice Address - Country:US
Practice Address - Phone:919-407-1927
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-07-19
Last Update Date:2016-07-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
No2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer