Individual
NATHAN BLACKHURST
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
PA
Contact information
Practice address
485 S DOBSON RD STE 110, CHANDLER, AZ 85224-5600
(480) 728-4470
(480) 728-4499
Mailing address
PO BOX 33269, PHOENIX, AZ 85067-3269
(602) 406-4786
(916) 636-4358
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
7553
AZ
363AS0400X
Surgical Physician Assistant
Primary
7553
AZ
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
Z250782
—
AZ
Enumeration date
04/05/2019
Last updated
01/09/2025
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