Provider Demographics
NPI:1851470835
Name:NATHANIEL, ALVITA KAY (NP)
Entity type:Individual
Prefix:DR
First Name:ALVITA
Middle Name:KAY
Last Name:NATHANIEL
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:209 E GRANDVIEW DR
Mailing Address - Street 2:
Mailing Address - City:PRINCETON
Mailing Address - State:WV
Mailing Address - Zip Code:24740-3844
Mailing Address - Country:US
Mailing Address - Phone:304-425-0645
Mailing Address - Fax:
Practice Address - Street 1:209 E GRANDVIEW DR
Practice Address - Street 2:
Practice Address - City:PRINCETON
Practice Address - State:WV
Practice Address - Zip Code:24740-3844
Practice Address - Country:US
Practice Address - Phone:304-425-0645
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-02
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV21794363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
WV0166621000Medicaid
WV0166621000Medicaid
WVP74601Medicare ID - Type Unspecified