Provider Demographics
NPI:1326715277
Name:BEAR, ALEXANDER (CNS)
Entity Type:Individual
Prefix:
First Name:ALEXANDER
Middle Name:
Last Name:BEAR
Suffix:
Gender:M
Credentials:CNS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2354 DEER BRUSH RD
Mailing Address - Street 2:
Mailing Address - City:GREENBANK
Mailing Address - State:WA
Mailing Address - Zip Code:98253-9773
Mailing Address - Country:US
Mailing Address - Phone:360-217-9334
Mailing Address - Fax:
Practice Address - Street 1:1705 MAIN ST
Practice Address - Street 2:
Practice Address - City:FREELAND
Practice Address - State:WA
Practice Address - Zip Code:98249-9423
Practice Address - Country:US
Practice Address - Phone:360-217-9334
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-08-27
Last Update Date:2024-02-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WANU61409281133N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133N00000XDietary & Nutritional Service ProvidersNutritionist