Provider Demographics
NPI:1093968406
Name:DEGRANDPRE, ZORA (ND)
Entity Type:Individual
Prefix:DR
First Name:ZORA
Middle Name:
Last Name:DEGRANDPRE
Suffix:
Gender:F
Credentials:ND
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10886 US HWY 12
Mailing Address - Street 2:
Mailing Address - City:RANDLE
Mailing Address - State:WA
Mailing Address - Zip Code:98377-3331
Mailing Address - Country:US
Mailing Address - Phone:360-852-6020
Mailing Address - Fax:360-694-9949
Practice Address - Street 1:10886 US HWY 12
Practice Address - Street 2:
Practice Address - City:RANDLE
Practice Address - State:WA
Practice Address - Zip Code:98377-3331
Practice Address - Country:US
Practice Address - Phone:360-852-6020
Practice Address - Fax:360-694-9949
Is Sole Proprietor?:Yes
Enumeration Date:2008-10-29
Last Update Date:2015-06-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WANT 60017673175F00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes175F00000XOther Service ProvidersNaturopath