Provider Demographics
NPI:1497041875
Name:ANDERSON, WHIMSY AUTUMN (ND)
Entity Type:Individual
Prefix:DR
First Name:WHIMSY
Middle Name:AUTUMN
Last Name:ANDERSON
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 1:1274 N LAUREL AVE APT 17
Mailing Address - Street 2:
Mailing Address - City:WEST HOLLYWOOD
Mailing Address - State:CA
Mailing Address - Zip Code:90046-5124
Mailing Address - Country:US
Mailing Address - Phone:323-762-3982
Mailing Address - Fax:
Practice Address - Street 1:7855 SANTA MONICA BLVD
Practice Address - Street 2:
Practice Address - City:WEST HOLLYWOOD
Practice Address - State:CA
Practice Address - Zip Code:90046-5344
Practice Address - Country:US
Practice Address - Phone:323-762-3982
Practice Address - Fax:323-650-6752
Is Sole Proprietor?:Yes
Enumeration Date:2011-06-23
Last Update Date:2011-06-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAC323175F00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes175F00000XOther Service ProvidersNaturopath