Provider Demographics
NPI:1619770484
Name:STADEM, NATHAN M
Entity type:Individual
Prefix:
First Name:NATHAN
Middle Name:M
Last Name:STADEM
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 1:25248 475TH AVE
Mailing Address - Street 2:
Mailing Address - City:BALTIC
Mailing Address - State:SD
Mailing Address - Zip Code:57003-5944
Mailing Address - Country:US
Mailing Address - Phone:605-610-7559
Mailing Address - Fax:
Practice Address - Street 1:25248 475TH AVE
Practice Address - Street 2:
Practice Address - City:BALTIC
Practice Address - State:SD
Practice Address - Zip Code:57003-5944
Practice Address - Country:US
Practice Address - Phone:605-610-7559
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-03-28
Last Update Date:2025-03-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program