Provider Demographics
NPI:1881891018
Name:ANDERSON, NATHAN ASHER (LAC)
Entity type:Individual
Prefix:
First Name:NATHAN
Middle Name:ASHER
Last Name:ANDERSON
Suffix:
Gender:M
Credentials:LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2856 E FORT LOWELL RD
Mailing Address - Street 2:
Mailing Address - City:TUCSON
Mailing Address - State:AZ
Mailing Address - Zip Code:85716-1518
Mailing Address - Country:US
Mailing Address - Phone:520-999-0800
Mailing Address - Fax:
Practice Address - Street 1:2856 E FORT LOWELL RD
Practice Address - Street 2:
Practice Address - City:TUCSON
Practice Address - State:AZ
Practice Address - Zip Code:85716-1518
Practice Address - Country:US
Practice Address - Phone:520-999-0800
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-06-29
Last Update Date:2021-08-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAAC 9744171100000X
AZ888171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist