Individual
NATHAN WHEATLEY
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
1090 W PARK PL, COEUR D ALENE, ID 83814-2785
(208) 292-0292
(208) 292-0705
Mailing address
PO BOX 3648, COEUR D ALENE, ID 83816-2522
Taxonomy
Speciality
Code
Description
License number
State
363AM0700X
Medical Physician Assistant
Primary
PA-1417
ID
Other
Enumeration date
10/17/2016
Last updated
10/17/2016
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