Provider Demographics
NPI:1790512234
Name:UNTAMED HEALTH
Entity type:Organization
Organization Name:UNTAMED HEALTH
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:FNP/OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:MATTHEW
Authorized Official - Middle Name:
Authorized Official - Last Name:NAQUIN
Authorized Official - Suffix:
Authorized Official - Credentials:FNP
Authorized Official - Phone:225-413-2265
Mailing Address - Street 1:5525 SUPERIOR DR STE C3
Mailing Address - Street 2:
Mailing Address - City:BATON ROUGE
Mailing Address - State:LA
Mailing Address - Zip Code:70816-8052
Mailing Address - Country:US
Mailing Address - Phone:225-496-1921
Mailing Address - Fax:225-217-8899
Practice Address - Street 1:5525 SUPERIOR DR STE C3
Practice Address - Street 2:
Practice Address - City:BATON ROUGE
Practice Address - State:LA
Practice Address - Zip Code:70816-8052
Practice Address - Country:US
Practice Address - Phone:225-496-1921
Practice Address - Fax:225-217-8899
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-09-18
Last Update Date:2025-02-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QU0200XAmbulatory Health Care FacilitiesClinic/CenterUrgent Care