Provider Demographics
NPI:1760052443
Name:HOLLENBECK, NATHAN L (R EEG T)
Entity Type:Individual
Prefix:
First Name:NATHAN
Middle Name:L
Last Name:HOLLENBECK
Suffix:
Gender:M
Credentials:R EEG T
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:903 GARLOCK ST S
Mailing Address - Street 2:
Mailing Address - City:SALEM
Mailing Address - State:OR
Mailing Address - Zip Code:97302-6022
Mailing Address - Country:US
Mailing Address - Phone:503-269-2621
Mailing Address - Fax:
Practice Address - Street 1:3270 LIBERTY RD S
Practice Address - Street 2:
Practice Address - City:SALEM
Practice Address - State:OR
Practice Address - Zip Code:97302-4560
Practice Address - Country:US
Practice Address - Phone:503-269-2621
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-06-25
Last Update Date:2021-06-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
133N00000X, 133NN1002X, 175F00000X, 293D00000X, 374K00000X
5811246ZE0500X, 246ZE0600X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes246ZE0600XTechnologists, Technicians & Other Technical Service ProvidersSpecialist/Technologist, OtherElectroneurodiagnostic
No133N00000XDietary & Nutritional Service ProvidersNutritionist
No133NN1002XDietary & Nutritional Service ProvidersNutritionistNutrition, Education
No175F00000XOther Service ProvidersNaturopath
No246ZE0500XTechnologists, Technicians & Other Technical Service ProvidersSpecialist/Technologist, OtherEEG
No293D00000XLaboratoriesPhysiological Laboratory
No374K00000XNursing Service Related ProvidersReligious Nonmedical Practitioner