Provider Demographics
NPI:1790167146
Name:ALTAVAS, NATHANIEL (MSN, FNP-C)
Entity Type:Individual
Prefix:
First Name:NATHANIEL
Middle Name:
Last Name:ALTAVAS
Suffix:
Gender:M
Credentials:MSN, FNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10304 SKILES DR
Mailing Address - Street 2:
Mailing Address - City:BAKERSFIELD
Mailing Address - State:CA
Mailing Address - Zip Code:93311-3066
Mailing Address - Country:US
Mailing Address - Phone:661-578-7233
Mailing Address - Fax:
Practice Address - Street 1:10304 SKILES DR
Practice Address - Street 2:
Practice Address - City:BAKERSFIELD
Practice Address - State:CA
Practice Address - Zip Code:93311-3066
Practice Address - Country:US
Practice Address - Phone:661-578-7233
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-06-22
Last Update Date:2015-06-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA95001758363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner