Provider Demographics
NPI:1003707316
Name:HUNTLEY, NATHANAEL
Entity type:Individual
Prefix:
First Name:NATHANAEL
Middle Name:
Last Name:HUNTLEY
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 1:1925 DOMINION WAY STE 101
Mailing Address - Street 2:
Mailing Address - City:COLORADO SPRINGS
Mailing Address - State:CO
Mailing Address - Zip Code:80918-1484
Mailing Address - Country:US
Mailing Address - Phone:719-300-5735
Mailing Address - Fax:
Practice Address - Street 1:1925 DOMINION WAY STE 101
Practice Address - Street 2:
Practice Address - City:COLORADO SPRINGS
Practice Address - State:CO
Practice Address - Zip Code:80918-1484
Practice Address - Country:US
Practice Address - Phone:719-300-5735
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-07-14
Last Update Date:2025-07-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program