| Doctor Name: | NATHAN KROEGEL |
| NPI Number: | 1811237514 |
| Entity Type Code: | Individual (1) |
| Gender: | M |
| Credentials: | |
| License Number: | |
| Business Practice Address: | 208 W Dl Ingram Ave. 27 Somdg Cannon Afb, NM - 881035014 |
| Business Phone Number: | 5757841108 |
| Business Fax Number: | |
| Mailing Address: | 1901 Dillon-wood Dr, PORTALES |
| State: | NM |
| Postal Code: | 881307193 |
| Phone Number: | 7024697334 |
| Fax Number: | |
| NPI Enumeration Date: | 02/18/2013 |
| NPI Last Update Date: | 10/24/2014 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 390200000X |
| License Number: | |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | |
| Taxonomy Type: | Student, Health Care |
| Taxonomy Classification: | Student in an Organized Health Care Education/Training Program |
| Taxonomy Specialization: | |
| Taxonomy Definition: | An individual who is enrolled in an organized health care education/training program leading to a degree, certification, registration, and/or licensure to provide health care. |