Provider Demographics
NPI:1538817911
Name:SPITZ, NATHEN
Entity type:Individual
Prefix:
First Name:NATHEN
Middle Name:
Last Name:SPITZ
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 1:416 GRANDVIEW CT
Mailing Address - Street 2:
Mailing Address - City:IOWA CITY
Mailing Address - State:IA
Mailing Address - Zip Code:52246-3219
Mailing Address - Country:US
Mailing Address - Phone:641-832-8556
Mailing Address - Fax:
Practice Address - Street 1:416 GRANDVIEW CT
Practice Address - Street 2:
Practice Address - City:IOWA CITY
Practice Address - State:IA
Practice Address - Zip Code:52246-3219
Practice Address - Country:US
Practice Address - Phone:641-832-8556
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-03-14
Last Update Date:2022-03-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA504AG5783Medicaid