Individual
NATHAN PETER FAA
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
LAC
Contact information
Practice address
1015 S BROADWAY STE 18, MINOT, ND 58701-4667
(701) 857-8500
(701) 857-8555
Mailing address
1015 S BROADWAY STE 18, MINOT, ND 58701-4667
(701) 857-8500
(701) 857-8555
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
Primary
1546
ND
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
054517
—
ND
01
—
27610
BCBS ND PROVIDER NUMBER
ND
Enumeration date
01/05/2007
Last updated
10/14/2010
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