Provider Demographics
NPI:1902668569
Name:KIEGEL, NATHANIEL WAYNE (RRT)
Entity Type:Individual
Prefix:
First Name:NATHANIEL
Middle Name:WAYNE
Last Name:KIEGEL
Suffix:
Gender:M
Credentials:RRT
Other - Prefix:
Other - First Name:NATHAN
Other - Middle Name:
Other - Last Name:KIEGEL
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:RRT
Mailing Address - Street 1:4588 MAXVILLE RD
Mailing Address - Street 2:
Mailing Address - City:BOONVILLE
Mailing Address - State:IN
Mailing Address - Zip Code:47601-9730
Mailing Address - Country:US
Mailing Address - Phone:812-455-0951
Mailing Address - Fax:
Practice Address - Street 1:400 SE 4TH ST
Practice Address - Street 2:
Practice Address - City:EVANSVILLE
Practice Address - State:IN
Practice Address - Zip Code:47713-1206
Practice Address - Country:US
Practice Address - Phone:812-421-2500
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-01-29
Last Update Date:2024-01-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN30007743A227900000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes227900000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersRespiratory Therapist, Registered