Healthcare Provider Details

I. General information

NPI: 1083630602
Provider Name (Legal Business Name): AKSEL G NORDESTGAARD M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/15/2006
Last Update Date: 01/25/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4700 POINT FOSDICK DR NW SUITE 307
GIG HARBOR WA
98335-1706
US

IV. Provider business mailing address

4700 POINT FOSDICK DR NW SUITE 307
GIG HARBOR WA
98335-1706
US

V. Phone/Fax

Practice location:
  • Phone: 253-857-8346
  • Fax: 253-857-0259
Mailing address:
  • Phone: 253-857-8346
  • Fax: 253-857-0259

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code173000000X
TaxonomyLegal Medicine
License NumberMD00028685
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: