Basic Information
| Provider Information | |||||||||
| NPI: | 1902992639 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | DINGELDEIN | ||||||||
| FirstName: | NATHAN | ||||||||
| MiddleName: | E | ||||||||
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| Credential: | PMHNP | ||||||||
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| Mailing Information | |||||||||
| Address1: | P.O. BOX 33784 | ||||||||
| Address2: | |||||||||
| City: | PHOENIZ | ||||||||
| State: | AZ | ||||||||
| PostalCode: | 850673784 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8035958164 | ||||||||
| FaxNumber: | 8335201481 | ||||||||
| Practice Location | |||||||||
| Address1: | 1052 29TH AVE SW | ||||||||
| Address2: | |||||||||
| City: | ALBANY | ||||||||
| State: | OR | ||||||||
| PostalCode: | 973213416 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5418125060 | ||||||||
| FaxNumber: | 5419267234 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 10/04/2006 | ||||||||
| LastUpdateDate: | 04/05/2021 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 03/15/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363LP0808X | 200250051NP | OR | N | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Psych/Mental Health | 363LP0808X | AP4149 | AZ | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Psych/Mental Health |
No ID Information.