Individual
NATHANIEL SPENCER HARRIMAN
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
M.S.S., PA-C
Contact information
Practice address
1896 E BABBITT LN, SAN LUIS, AZ 85349
(928) 722-6112
(928) 722-6113
Mailing address
PO BOX 1669, SAN LUIS, AZ 85349
(928) 722-6112
(928) 722-6113
Taxonomy
Speciality
Code
Description
License number
State
363AM0700X
Medical Physician Assistant
Primary
6552
AZ
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
190373
—
AZ
Enumeration date
10/21/2016
Last updated
12/19/2016
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