Healthcare Provider Details

I. General information

NPI: 1548289069
Provider Name (Legal Business Name): MICHAEL NORD NAVY IDC
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/18/2006
Last Update Date: 12/19/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7481 BRIDLEVALE BLVD NW
BREMERTON WA
98311-8987
US

IV. Provider business mailing address

7481 BRIDLEVALE BLVD NW
BREMERTON WA
98311-8987
US

V. Phone/Fax

Practice location:
  • Phone: 360-315-4208
  • Fax: 360-396-4247
Mailing address:
  • Phone: 360-649-7501
  • Fax: 360-396-4247

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1710I1002X
TaxonomyIndependent Duty Corpsman
License Number
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: