Healthcare Provider Details

I. General information

NPI: 1023350055
Provider Name (Legal Business Name): VIRIDITAS NATUROPATHIC MEDICINE, PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/15/2013
Last Update Date: 03/15/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

27 SW RUSSELL AVE.
STEVENSON WA
98648-1457
US

IV. Provider business mailing address

27 SW RUSSELL AVE. P.O. BOX 1457
STEVENSON WA
98648-1457
US

V. Phone/Fax

Practice location:
  • Phone: 509-427-3624
  • Fax:
Mailing address:
  • Phone: 509-427-3624
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code175F00000X
TaxonomyNaturopath
License NumberNT60319044
License Number StateWA

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name: DR. ANNA IRENE WIEMAN
Title or Position: OWNER
Credential: N.D.
Phone: 509-427-3624