Basic Information
| Provider Information | |||||||||
| NPI: | 1053543066 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | KRAVITZ | ||||||||
| FirstName: | NATHANIEL | ||||||||
| MiddleName: | |||||||||
| NamePrefix: | MR. | ||||||||
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| Credential: | RN, MN, PMHNP | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1587 PACIFIC RIDGE LN SE | ||||||||
| Address2: | |||||||||
| City: | JEFFERSON | ||||||||
| State: | OR | ||||||||
| PostalCode: | 973529654 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5033617758 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 2045 SILVERTON RD NE | ||||||||
| Address2: | |||||||||
| City: | SALEM | ||||||||
| State: | OR | ||||||||
| PostalCode: | 973010100 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5035885351 | ||||||||
| FaxNumber: | 5035854908 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/10/2009 | ||||||||
| LastUpdateDate: | 07/29/2019 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 101YA0400X | 23426 | OR | N | Behavioral Health & Social Service Providers | Counselor | Addiction (Substance Use Disorder) | 163WP0808X | 200841283RN | OR | N | Nursing Service Providers | Registered Nurse | Psych/Mental Health | 363LP0808X | 201050130NP | OR | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Psych/Mental Health |
No ID Information.