Provider Demographics
NPI:1700134293
Name:JEAN, NATHALIE (MD)
Entity type:Individual
Prefix:DR
First Name:NATHALIE
Middle Name:
Last Name:JEAN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:607 S 24TH AVE # 367
Mailing Address - Street 2:
Mailing Address - City:WAUSAU
Mailing Address - State:WI
Mailing Address - Zip Code:54401-5226
Mailing Address - Country:US
Mailing Address - Phone:347-421-2862
Mailing Address - Fax:
Practice Address - Street 1:105 W 8TH AVE STE 1000
Practice Address - Street 2:
Practice Address - City:SPOKANE
Practice Address - State:WA
Practice Address - Zip Code:99204-2327
Practice Address - Country:US
Practice Address - Phone:509-474-4500
Practice Address - Fax:509-227-7070
Is Sole Proprietor?:Yes
Enumeration Date:2012-08-15
Last Update Date:2024-09-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036.152627207R00000X
WAMD61260915207RN0300X
WI72878207RN0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RN0300XAllopathic & Osteopathic PhysiciansInternal MedicineNephrology
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine