Provider Demographics
NPI:1720653090
Name:HEATH, NATHAN R
Entity Type:Individual
Prefix:MR
First Name:NATHAN
Middle Name:R
Last Name:HEATH
Suffix:
Gender:M
Credentials:
Other - Prefix:MR
Other - First Name:NATE
Other - Middle Name:
Other - Last Name:HEATH
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:
Mailing Address - Street 1:769 SUNSET BLVD APT 8
Mailing Address - Street 2:
Mailing Address - City:MANSFIELD
Mailing Address - State:OH
Mailing Address - Zip Code:44907-2660
Mailing Address - Country:US
Mailing Address - Phone:419-631-3687
Mailing Address - Fax:
Practice Address - Street 1:769 SUNSET BLVD APT 8
Practice Address - Street 2:
Practice Address - City:MANSFIELD
Practice Address - State:OH
Practice Address - Zip Code:44907-2660
Practice Address - Country:US
Practice Address - Phone:419-631-3687
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-05-20
Last Update Date:2021-05-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172A00000XOther Service ProvidersDriver
No174200000XOther Service ProvidersMeals
No347C00000XTransportation ServicesPrivate Vehicle