Provider Demographics
NPI:1194416255
Name:NEPO, NATHAN JAMES (FNP)
Entity type:Individual
Prefix:
First Name:NATHAN
Middle Name:JAMES
Last Name:NEPO
Suffix:
Gender:M
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11550 INDIAN HILLS RD STE 371
Mailing Address - Street 2:
Mailing Address - City:MISSION HILLS
Mailing Address - State:CA
Mailing Address - Zip Code:91345-1252
Mailing Address - Country:US
Mailing Address - Phone:818-365-1194
Mailing Address - Fax:818-898-3835
Practice Address - Street 1:11550 INDIAN HILLS RD STE 371
Practice Address - Street 2:
Practice Address - City:MISSION HILLS
Practice Address - State:CA
Practice Address - Zip Code:91345-1252
Practice Address - Country:US
Practice Address - Phone:818-365-1194
Practice Address - Fax:818-898-3835
Is Sole Proprietor?:No
Enumeration Date:2023-05-18
Last Update Date:2023-11-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
CA95025488363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program