Healthcare Provider Details

I. General information

NPI: 1497941694
Provider Name (Legal Business Name): ANDREW IVERSON N.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/20/2007
Last Update Date: 01/15/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5609 S LAWRENCE ST
TACOMA WA
98409-5319
US

IV. Provider business mailing address

5609 S LAWRENCE ST
TACOMA WA
98409-5319
US

V. Phone/Fax

Practice location:
  • Phone: 253-752-7377
  • Fax: 253-752-8001
Mailing address:
  • Phone: 253-752-7377
  • Fax: 253-752-8001

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code175F00000X
TaxonomyNaturopath
License NumberNT 00001266
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: