Healthcare Provider Details

I. General information

NPI: 1326386087
Provider Name (Legal Business Name): ALEXANDRA DEMETRO, ND
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/30/2013
Last Update Date: 01/30/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

408 E MAIN ST BATTLE GROUND HEALING ARTS
BATTLE GROUND WA
98604
US

IV. Provider business mailing address

408 E. MAIN ST
BATTLE GROUND WA
98604-9999
US

V. Phone/Fax

Practice location:
  • Phone: 360-687-0800
  • Fax: 360-687-1600
Mailing address:
  • Phone: 360-687-0800
  • Fax: 360-687-1600

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code175F00000X
TaxonomyNaturopath
License NumberNT60254488
License Number StateWA

VIII. Authorized Official

Name: DR. ALEXANDRA KATHERINE DEMETRO
Title or Position: N.D.
Credential:
Phone: 360-687-0800