Healthcare Provider Details

I. General information

NPI: 1619931219
Provider Name (Legal Business Name): BETH W. NAUERT MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/12/2006
Last Update Date: 12/04/2020
Certification Date: 12/04/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

126 AUBURN AVE STE 300
AUBURN WA
98002-5082
US

IV. Provider business mailing address

955 POWELL AVE SW
RENTON WA
98057-2908
US

V. Phone/Fax

Practice location:
  • Phone: 537-350-1662
  • Fax: 253-833-8987
Mailing address:
  • Phone: 425-277-1311
  • Fax: 425-277-1566

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberMD60461563
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: