Provider Demographics
NPI:1841990058
Name:THELLMAN, NATHAN MICHAEL
Entity type:Individual
Prefix:
First Name:NATHAN
Middle Name:MICHAEL
Last Name:THELLMAN
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4400 MELROSE DR LOT 19
Mailing Address - Street 2:
Mailing Address - City:WOOSTER
Mailing Address - State:OH
Mailing Address - Zip Code:44691-1858
Mailing Address - Country:US
Mailing Address - Phone:330-885-3317
Mailing Address - Fax:
Practice Address - Street 1:4400 MELROSE DR LOT 19
Practice Address - Street 2:
Practice Address - City:WOOSTER
Practice Address - State:OH
Practice Address - Zip Code:44691-1858
Practice Address - Country:US
Practice Address - Phone:330-885-3317
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-03-06
Last Update Date:2023-03-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH376J00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes376J00000XNursing Service Related ProvidersHomemaker