Individual
NATHANIEL D BENNETT
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PAC
Contact information
Practice address
1970 ROANOKE BLVD, SALEM, VA 24153-6404
(540) 982-2463
Mailing address
3343 CLARA AVE SW, ROANOKE, VA 24018-1301
(540) 362-1594
(276) 236-8899
Taxonomy
Speciality
Code
Description
License number
State
363AM0700X
Medical Physician Assistant
Primary
0110-001867
VA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
010116309
—
VA
Enumeration date
07/17/2006
Last updated
07/16/2014
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