Provider Demographics
NPI:1952089575
Name:CHEVRIN, NATHANAEL P
Entity Type:Individual
Prefix:
First Name:NATHANAEL
Middle Name:P
Last Name:CHEVRIN
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11 LINDEN ST
Mailing Address - Street 2:
Mailing Address - City:CORAM
Mailing Address - State:NY
Mailing Address - Zip Code:11727-1113
Mailing Address - Country:US
Mailing Address - Phone:347-938-8401
Mailing Address - Fax:
Practice Address - Street 1:379 MOONEY POND RD
Practice Address - Street 2:
Practice Address - City:SELDEN
Practice Address - State:NY
Practice Address - Zip Code:11784-3416
Practice Address - Country:US
Practice Address - Phone:516-658-3754
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-07-05
Last Update Date:2023-07-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY826981163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse