Individual
NATHAN JOHN WILSON HEACOCK
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
CRNA
Contact information
Practice address
1800 N CALIFORNIA ST, STOCKTON, CA 95204-6019
(209) 943-2000
Mailing address
9687 MARQUIS CT, ELK GROVE, CA 95758-4674
(530) 957-6828
Taxonomy
Speciality
Code
Description
License number
State
163W00000X
Registered Nurse
RN95178472
CA
367500000X
Certified Registered Nurse Anesthetist
Primary
95001167
CA
Other
Enumeration date
03/30/2019
Last updated
08/13/2019
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