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
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Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:801 CHATEAUGAY RD
Mailing Address - Street 2:
Mailing Address - City:KNOXVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37923-2017
Mailing Address - Country:US
Mailing Address - Phone:443-465-5528
Mailing Address - Fax:
Practice Address - Street 1:801 CHATEAUGAY RD
Practice Address - Street 2:
Practice Address - City:KNOXVILLE
Practice Address - State:TN
Practice Address - Zip Code:37923-2017
Practice Address - Country:US
Practice Address - Phone:443-465-5528
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-05-05
Last Update Date:2022-05-05
Deactivation Date:
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Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant