Provider Demographics
NPI:1174990238
Name:ANDERSON, NATHAN
Entity type:Individual
Prefix:
First Name:NATHAN
Middle Name:
Last Name:ANDERSON
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 1:7475 MINERAL POINT RD
Mailing Address - Street 2:STE 15
Mailing Address - City:MADISON
Mailing Address - State:WI
Mailing Address - Zip Code:53717-1720
Mailing Address - Country:US
Mailing Address - Phone:608-821-0075
Mailing Address - Fax:
Practice Address - Street 1:7475 MINERAL POINT RD
Practice Address - Street 2:STE 15
Practice Address - City:MADISON
Practice Address - State:WI
Practice Address - Zip Code:53717-1720
Practice Address - Country:US
Practice Address - Phone:608-821-0075
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-08-25
Last Update Date:2015-08-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI1470-60237700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes237700000XSpeech, Language and Hearing Service ProvidersHearing Instrument Specialist