Healthcare Provider Details

I. General information

NPI: 1760560973
Provider Name (Legal Business Name): KAITEN A RIVERS ND
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/02/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1302 NORTH I STREET
TACOMA WA
98403-2139
US

IV. Provider business mailing address

1302 NORTH I STREET
TACOMA WA
98403-2139
US

V. Phone/Fax

Practice location:
  • Phone: 253-572-0939
  • Fax: 253-572-5101
Mailing address:
  • Phone: 253-572-0939
  • Fax: 253-572-5101

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code175F00000X
TaxonomyNaturopath
License NumberNT00000651
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: