MEDICARE: DR. NATHAN SPENCER N.D.

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	175F00000X	Naturopath	1432	WA

General Provider Information

NPI Number	:	1568531291
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. NATHAN SPENCER N.D.

Provider Business Mailing Address
First Line	:	2722 214TH AVE E
Second Line	:
City	:	LAKE TAPPS
State	:	WA
Zip	:	98391-6245
Country	:	US
Telephone Number	:	253-862-3501
Fax Number	:	253-862-3509

Provider Business Practice Location Address
First Line	:	2722 214TH AVE E
Second Line	:
City	:	LAKE TAPPS
State	:	WA
Zip	:	98391-6245
Country	:	US
Telephone Number	:	253-862-3501
Fax Number	:	253-862-3509

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	11/07/2006
Last Update Date	:	07/08/2007

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