Provider Demographics
NPI:1235406877
Name:DEICHERT INTEGRATIVE HEALTH LLC
Entity Type:Organization
Organization Name:DEICHERT INTEGRATIVE HEALTH LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:
Authorized Official - Last Name:DEICHERT
Authorized Official - Suffix:
Authorized Official - Credentials:ARNP
Authorized Official - Phone:206-795-5760
Mailing Address - Street 1:20624 SE 119TH ST
Mailing Address - Street 2:
Mailing Address - City:ISSAQUAH
Mailing Address - State:WA
Mailing Address - Zip Code:98027-5402
Mailing Address - Country:US
Mailing Address - Phone:206-795-5760
Mailing Address - Fax:
Practice Address - Street 1:12600 SE 38TH ST STE 130
Practice Address - Street 2:
Practice Address - City:BELLEVUE
Practice Address - State:WA
Practice Address - Zip Code:98006
Practice Address - Country:US
Practice Address - Phone:425-679-6056
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-11-28
Last Update Date:2018-12-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAAP60178142363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Single Specialty