Provider Demographics
NPI:1710314539
Name:MAGTOTO, NATHANIEL D (APRN)
Entity Type:Individual
Prefix:MR
First Name:NATHANIEL
Middle Name:D
Last Name:MAGTOTO
Suffix:
Gender:M
Credentials:APRN
Other - Prefix:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 98978
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89193-8978
Mailing Address - Country:US
Mailing Address - Phone:702-216-3346
Mailing Address - Fax:702-671-6883
Practice Address - Street 1:1501 E CALVADA BLVD
Practice Address - Street 2:
Practice Address - City:PAHRUMP
Practice Address - State:NV
Practice Address - Zip Code:89048-5807
Practice Address - Country:US
Practice Address - Phone:775-727-5500
Practice Address - Fax:775-727-5696
Is Sole Proprietor?:No
Enumeration Date:2013-10-11
Last Update Date:2015-11-02
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CA23717363LF0000X
NVAPRN001641363LF0000X, 363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
NV1710314539Medicaid
NVPENDINGMedicare PIN