MEDICARE: NORDSTROM INC & SUBSIDIARIES

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	335E00000X	Prosthetic/Orthotic Supplier

General Provider Information

NPI Number	:	1568488922
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	NORDSTROM INC & SUBSIDIARIES

Provider Business Mailing Address
First Line	:	1617 6TH AVE
Second Line	:	ATTN: PROSTHESIS
City	:	SEATTLE
State	:	WA
Zip	:	98101-1707
Country	:	US
Telephone Number	:	206-454-4060
Fax Number	:	206-454-1279

Provider Business Practice Location Address
First Line	:	4321 LA JOLLA VILLAGE DR
Second Line	:
City	:	SAN DIEGO
State	:	CA
Zip	:	92122-1201
Country	:	US
Telephone Number	:	858-457-4575
Fax Number	:

Authorized Official
Title or Position	:	PROSTHESIS OFFICE MANAGER
Name	:	KRESHA B BRITTON
Credential	:
Telephone Number	:	206-454-4060

Provider Enumeration Date	:	07/15/2006
Last Update Date	:	06/16/2015

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