Basic Information
| Provider Information | |||||||||
| NPI: | 1972965416 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | REEVE | ||||||||
| FirstName: | NATHANIEL | ||||||||
| MiddleName: | HARRISON | ||||||||
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| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 933 BRADBURY DR SE STE 2222 | ||||||||
| Address2: | |||||||||
| City: | ALBUQUERQUE | ||||||||
| State: | NM | ||||||||
| PostalCode: | 871064375 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5052729831 | ||||||||
| FaxNumber: | 5052724156 | ||||||||
| Practice Location | |||||||||
| Address1: | 3001 BROADMOOR BLVD NE | ||||||||
| Address2: | |||||||||
| City: | RIO RANCHO | ||||||||
| State: | NM | ||||||||
| PostalCode: | 871442100 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5052729831 | ||||||||
| FaxNumber: | 5052724156 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 03/23/2016 | ||||||||
| LastUpdateDate: | 09/08/2022 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 07/28/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207Y00000X | MD61144891 | WA | N | Allopathic & Osteopathic Physicians | Otolaryngology | 207Y00000X | MD2022-1264 | NM | Y | Allopathic & Osteopathic Physicians | Otolaryngology |
ID Information
| ID | Type | State | Issuer | Description | 1972965416 | 05 | WA | MEDICAID |