Provider Demographics
NPI:1801696885
Name:MYERS, NATHINA NICHOLE (LMT1793)
Entity type:Individual
Prefix:MRS
First Name:NATHINA
Middle Name:NICHOLE
Last Name:MYERS
Suffix:
Gender:
Credentials:LMT1793
Other - Prefix:MS
Other - First Name:NATHINA
Other - Middle Name:NICHOLE
Other - Last Name:ST. PIERRE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LMT1793
Mailing Address - Street 1:113 6TH AVE SE STE 5400
Mailing Address - Street 2:
Mailing Address - City:WATFORD CITY
Mailing Address - State:ND
Mailing Address - Zip Code:58854-7331
Mailing Address - Country:US
Mailing Address - Phone:701-842-3100
Mailing Address - Fax:
Practice Address - Street 1:113 6TH AVE SE STE 5400
Practice Address - Street 2:
Practice Address - City:WATFORD CITY
Practice Address - State:ND
Practice Address - Zip Code:58854-7331
Practice Address - Country:US
Practice Address - Phone:701-842-3100
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-03-18
Last Update Date:2025-03-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ND1793225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist