Provider Demographics
NPI:1164397170
Name:POMERLEAU, NATHAN
Entity type:Individual
Prefix:
First Name:NATHAN
Middle Name:
Last Name:POMERLEAU
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 1:3816 DODSON CHAPEL RD APT 601
Mailing Address - Street 2:
Mailing Address - City:HERMITAGE
Mailing Address - State:TN
Mailing Address - Zip Code:37076-3790
Mailing Address - Country:US
Mailing Address - Phone:413-455-4664
Mailing Address - Fax:
Practice Address - Street 1:3816 DODSON CHAPEL RD APT 601
Practice Address - Street 2:
Practice Address - City:HERMITAGE
Practice Address - State:TN
Practice Address - Zip Code:37076-3790
Practice Address - Country:US
Practice Address - Phone:413-455-4664
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-10-08
Last Update Date:2025-10-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN260549163WP0809X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WP0809XNursing Service ProvidersRegistered NursePsychiatric/Mental Health, Adult