Provider Demographics
NPI:1902992639
Name:DINGELDEIN, NATHAN E (PMHNP)
Entity Type:Individual
Prefix:
First Name:NATHAN
Middle Name:E
Last Name:DINGELDEIN
Suffix:
Gender:M
Credentials:PMHNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:P.O. BOX 33784
Mailing Address - Street 2:
Mailing Address - City:PHOENIZ
Mailing Address - State:AZ
Mailing Address - Zip Code:85067-3784
Mailing Address - Country:US
Mailing Address - Phone:803-595-8164
Mailing Address - Fax:833-520-1481
Practice Address - Street 1:1052 29TH AVE SW
Practice Address - Street 2:
Practice Address - City:ALBANY
Practice Address - State:OR
Practice Address - Zip Code:97321-3416
Practice Address - Country:US
Practice Address - Phone:541-812-5060
Practice Address - Fax:541-926-7234
Is Sole Proprietor?:No
Enumeration Date:2006-10-04
Last Update Date:2021-04-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR200250051NP363LP0808X
AZAP4149363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR114182Medicare ID - Type Unspecified
ORP35150Medicare UPIN