Provider Demographics
NPI:1841567468
Name:PICKEL, NATHAN (MED, LAT, ATC)
Entity Type:Individual
Prefix:MR
First Name:NATHAN
Middle Name:
Last Name:PICKEL
Suffix:
Gender:M
Credentials:MED, LAT, ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10408 HADDINGTON DR NW
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28269-6955
Mailing Address - Country:US
Mailing Address - Phone:618-237-8502
Mailing Address - Fax:
Practice Address - Street 1:10408 HADDINGTON DR NW
Practice Address - Street 2:
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28269-6955
Practice Address - Country:US
Practice Address - Phone:618-237-8502
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-11-28
Last Update Date:2022-03-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC20142255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer