Individual
DR. NATHAN VICKNAIR
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
STUDENT
Contact information
Practice address
400 W 16TH ST, PUEBLO, CO 81003-2745
(719) 584-4000
Mailing address
216 W 10TH AVE STE 202, KENNEWICK, WA 99336-6304
(509) 221-5510
Taxonomy
Speciality
Code
Description
License number
State
390200000X
Student in an Organized Health Care Education/Training Program
Primary
—
—
Other
Enumeration date
03/27/2020
Last updated
09/20/2023
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