Healthcare Provider Details

I. General information

NPI: 1700266798
Provider Name (Legal Business Name): NICHOLE THORSVIK D.O.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/04/2015
Last Update Date: 11/03/2022
Certification Date: 11/03/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2209 E 32ND ST
TACOMA WA
98404-4922
US

IV. Provider business mailing address

2209 E 32ND ST
TACOMA WA
98404-4922
US

V. Phone/Fax

Practice location:
  • Phone: 253-593-0232
  • Fax:
Mailing address:
  • Phone: 253-593-0232
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code204D00000X
TaxonomyNeuromusculoskeletal Medicine & OMM Physician
License Number294366
License Number StateNY
# 2
Primary TaxonomyY
Taxonomy Code204D00000X
TaxonomyNeuromusculoskeletal Medicine & OMM Physician
License Number102205970
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: