Provider Demographics
NPI:1184060980
Name:KAISER, NATHAN EDWARD (APRN)
Entity type:Individual
Prefix:
First Name:NATHAN
Middle Name:EDWARD
Last Name:KAISER
Suffix:
Gender:
Credentials:APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:16624 OAK ST
Mailing Address - Street 2:
Mailing Address - City:OMAHA
Mailing Address - State:NE
Mailing Address - Zip Code:68130-2050
Mailing Address - Country:US
Mailing Address - Phone:308-882-1587
Mailing Address - Fax:509-491-3031
Practice Address - Street 1:8508 W GAGE BLVD STE A101
Practice Address - Street 2:
Practice Address - City:KENNEWICK
Practice Address - State:WA
Practice Address - Zip Code:99336-8106
Practice Address - Country:US
Practice Address - Phone:509-222-1275
Practice Address - Fax:509-491-3031
Is Sole Proprietor?:No
Enumeration Date:2013-05-20
Last Update Date:2025-03-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE68507163W00000X
IAA133921363L00000X
NE111602363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No163W00000XNursing Service ProvidersRegistered Nurse
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA1184060980OtherWELLMARK BCBS OF IA
IA088710028Medicare PIN
NE420680355-12Medicaid
NE68507OtherRN LICENSE
IA1184060980Medicaid
IAA133921OtherIA ARNP LICENSE