Healthcare Provider Details

I. General information

NPI: 1346579208
Provider Name (Legal Business Name): TRAVIS THURSTON N.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/23/2009
Last Update Date: 05/29/2026
Certification Date: 05/29/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

203 4TH AVE E STE 305
OLYMPIA WA
98501-1188
US

IV. Provider business mailing address

203 4TH AVE E STE 305
OLYMPIA WA
98501-1188
US

V. Phone/Fax

Practice location:
  • Phone: 808-343-5501
  • Fax: 808-443-0842
Mailing address:
  • Phone: 808-343-5501
  • Fax: 808-443-0842

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code175F00000X
TaxonomyNaturopath
License NumberNT61229191
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: