Provider Demographics
NPI:1447269923
Name:NATHANIEL VAN VALIN
Entity type:Organization
Organization Name:NATHANIEL VAN VALIN
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN ASSISTANT
Authorized Official - Prefix:
Authorized Official - First Name:NATHANIEL
Authorized Official - Middle Name:ASHBY
Authorized Official - Last Name:VAN VALIN
Authorized Official - Suffix:
Authorized Official - Credentials:PAC
Authorized Official - Phone:509-924-7010
Mailing Address - Street 1:1925 N HARMONY LN
Mailing Address - Street 2:
Mailing Address - City:SPOKANE VALLEY
Mailing Address - State:WA
Mailing Address - Zip Code:99016-8418
Mailing Address - Country:US
Mailing Address - Phone:509-570-6133
Mailing Address - Fax:
Practice Address - Street 1:15425 E MISSION AVE
Practice Address - Street 2:
Practice Address - City:SPOKANE VALLEY
Practice Address - State:WA
Practice Address - Zip Code:99037-9505
Practice Address - Country:US
Practice Address - Phone:509-924-7010
Practice Address - Fax:509-924-7532
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-05
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAPA10004910363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedicalGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WAPA10004910OtherSTATE LICENSE NUMBER
WAMV1308445OtherDEA NUMBER