Healthcare Provider Details

I. General information

NPI: 1124265210
Provider Name (Legal Business Name): TIM GERSTMAR ND
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/12/2009
Last Update Date: 03/03/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

16455 NE 85TH ST SUITE 102
REDMOND WA
98052-3673
US

IV. Provider business mailing address

16455 NE 85TH ST SUITE 102
REDMOND WA
98052-3673
US

V. Phone/Fax

Practice location:
  • Phone: 425-483-6663
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code175F00000X
TaxonomyNaturopath
License NumberNT 60062476
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: