Provider Demographics
NPI:1851864433
Name:BLISS, NATHAN (PA)
Entity Type:Individual
Prefix:
First Name:NATHAN
Middle Name:
Last Name:BLISS
Suffix:
Gender:M
Credentials:PA
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Mailing Address - Street 1:7989 N HWY 125
Mailing Address - Street 2:
Mailing Address - City:OAK CITY
Mailing Address - State:UT
Mailing Address - Zip Code:84649
Mailing Address - Country:US
Mailing Address - Phone:435-406-1314
Mailing Address - Fax:
Practice Address - Street 1:140 WHITE SAGE AVE
Practice Address - Street 2:
Practice Address - City:DELTA
Practice Address - State:UT
Practice Address - Zip Code:84624-8928
Practice Address - Country:US
Practice Address - Phone:435-864-3333
Practice Address - Fax:435-864-2790
Is Sole Proprietor?:No
Enumeration Date:2019-01-07
Last Update Date:2020-04-28
Deactivation Date:
Deactivation Code:
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Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant