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Individual
NATHAN WALLENFANG
Active
Individual
NATHAN WALLENFANG
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
NP
Taxonomy
Speciality
Code
Description
License number
State
363L00000X
Nurse Practitioner
209-020256
IL
363L00000X
Nurse Practitioner
6862
WI
363LP0808X
Psychiatric/Mental Health Nurse Practitioner
Primary
6862
WI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
100059198
—
WI
05
—
100159456
—
WI
Enumeration date
05/06/2016
Last updated
01/16/2026
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