Provider Demographics
NPI:1588300370
Name:HOLBROOK, NATHANAEL WELLS (PA)
Entity type:Individual
Prefix:
First Name:NATHANAEL
Middle Name:WELLS
Last Name:HOLBROOK
Suffix:
Gender:M
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:598 E 13TH AVE
Mailing Address - Street 2:
Mailing Address - City:EUGENE
Mailing Address - State:OR
Mailing Address - Zip Code:97401-4783
Mailing Address - Country:US
Mailing Address - Phone:598-363-3473
Mailing Address - Fax:541-636-3480
Practice Address - Street 1:598 E 13TH AVE
Practice Address - Street 2:
Practice Address - City:EUGENE
Practice Address - State:OR
Practice Address - Zip Code:97401-4783
Practice Address - Country:US
Practice Address - Phone:541-636-3473
Practice Address - Fax:541-305-4449
Is Sole Proprietor?:No
Enumeration Date:2022-05-05
Last Update Date:2025-09-25
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
363A00000X
ORPA226123363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant