Basic Information
| Provider Information | |||||||||
| NPI: | 1356617518 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | RAINWATER | ||||||||
| FirstName: | NATHAN | ||||||||
| MiddleName: | ALLEN | ||||||||
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| Credential: | D.O. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1134 N 500 W | ||||||||
| Address2: | SUITE 101 | ||||||||
| City: | PROVO | ||||||||
| State: | UT | ||||||||
| PostalCode: | 846043383 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8013578310 | ||||||||
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| Practice Location | |||||||||
| Address1: | 1134 N 500 W | ||||||||
| Address2: | SUITE 101 | ||||||||
| City: | PROVO | ||||||||
| State: | UT | ||||||||
| PostalCode: | 846043383 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8013578310 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 03/31/2012 | ||||||||
| LastUpdateDate: | 09/22/2015 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207R00000X | MRO-1274 | ID | N | Allopathic & Osteopathic Physicians | Internal Medicine | 207R00000X | 9218046-1204 | UT | Y | Allopathic & Osteopathic Physicians | Internal Medicine |
No ID Information.