Provider Demographics
NPI:1730451733
Name:MCNIEL, NATHANAEL PAUL (PA-C)
Entity type:Individual
Prefix:MR
First Name:NATHANAEL
Middle Name:PAUL
Last Name:MCNIEL
Suffix:
Gender:M
Credentials:PA-C
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Mailing Address - Street 1:3533 SOUTHERN BLVD
Mailing Address - Street 2:STE 3000
Mailing Address - City:KETTERING
Mailing Address - State:OH
Mailing Address - Zip Code:45429-1280
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:3533 SOUTHERN BLVD
Practice Address - Street 2:STE 3000
Practice Address - City:KETTERING
Practice Address - State:OH
Practice Address - Zip Code:45429-1280
Practice Address - Country:US
Practice Address - Phone:937-299-8242
Practice Address - Fax:937-299-8245
Is Sole Proprietor?:No
Enumeration Date:2012-02-07
Last Update Date:2023-01-12
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
OH003451363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0102814Medicaid
OH0102814Medicaid
OHP01303981Medicare PIN