Provider Demographics
NPI:1811553019
Name:BEALL, NATHANAEL LAWRENCE
Entity Type:Individual
Prefix:
First Name:NATHANAEL
Middle Name:LAWRENCE
Last Name:BEALL
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 1:32 W WINCHESTER ST
Mailing Address - Street 2:
Mailing Address - City:MURRAY
Mailing Address - State:UT
Mailing Address - Zip Code:84107-5607
Mailing Address - Country:US
Mailing Address - Phone:801-263-6367
Mailing Address - Fax:801-263-6370
Practice Address - Street 1:32 W WINCHESTER ST
Practice Address - Street 2:
Practice Address - City:MURRAY
Practice Address - State:UT
Practice Address - Zip Code:84107-5607
Practice Address - Country:US
Practice Address - Phone:801-263-6367
Practice Address - Fax:801-263-6370
Is Sole Proprietor?:No
Enumeration Date:2019-05-13
Last Update Date:2019-05-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes175T00000XOther Service ProvidersPeer Specialist