| Doctor Name: | NATHAN J NISTLER |
| NPI Number: | 1174775514 |
| Entity Type Code: | Individual (1) |
| Gender: | M |
| Credentials: | PA-C |
| License Number: | 10514 |
| Business Practice Address: | 3580 Arcade Stq Vadnais Heights, MN - 551277135 |
| Business Phone Number: | 6519685770 |
| Business Fax Number: | 6519685775 |
| Mailing Address: | 710 Commerce Dr Ste 200, WOODBURY |
| State: | MN |
| Postal Code: | 551254925 |
| Phone Number: | 6519685042 |
| Fax Number: | 6519685904 |
| NPI Enumeration Date: | 10/16/2008 |
| NPI Last Update Date: | 07/10/2015 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 363AM0700X |
| License Number: | 10514 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | MN |
| Taxonomy Type: | Physician Assistants & Advanced Practice Nursing Providers |
| Taxonomy Classification: | Physician Assistant |
| Taxonomy Specialization: | Medical |
| Taxonomy Definition: | |