Healthcare Provider Details

I. General information

NPI: 1427112200
Provider Name (Legal Business Name): BRIAN DEAN REWERTS ND
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/19/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1299 156TH AVE NE STE 123
BELLEVUE WA
98007-7562
US

IV. Provider business mailing address

1299 156TH AVE NE STE 123
BELLEVUE WA
98007-7562
US

V. Phone/Fax

Practice location:
  • Phone: 425-614-4000
  • Fax: 425-641-0880
Mailing address:
  • Phone: 425-614-4000
  • Fax: 425-641-0880

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code175F00000X
TaxonomyNaturopath
License NumberNT00001283
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: