Healthcare Provider Details

I. General information

NPI: 1598935835
Provider Name (Legal Business Name): ERIC S NISSEN N.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/03/2008
Last Update Date: 03/03/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2719 E MADISON ST SUITE 203
SEATTLE WA
98112-4752
US

IV. Provider business mailing address

2719 E MADISON ST SUITE 203
SEATTLE WA
98112-4752
US

V. Phone/Fax

Practice location:
  • Phone: 206-568-7545
  • Fax: 206-568-8298
Mailing address:
  • Phone: 206-568-7545
  • Fax: 206-568-8298

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code175F00000X
TaxonomyNaturopath
License NumberNT00001468
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: