Healthcare Provider Details

I. General information

NPI: 1154766962
Provider Name (Legal Business Name): NATHAN SWISS DO
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/07/2013
Last Update Date: 10/16/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

413 LILLY RD NE
OLYMPIA WA
98506-5133
US

IV. Provider business mailing address

PO BOX 94625
SEATTLE WA
98124-6925
US

V. Phone/Fax

Practice location:
  • Phone: 360-491-9480
  • Fax:
Mailing address:
  • Phone: 425-407-1000
  • Fax: 425-407-1112

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License NumberOP60834239
License Number StateWA
# 2
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: