Provider Demographics
NPI:1568488922
Name:NORDSTROM INC & SUBSIDIARIES
Entity Type:Organization
Organization Name:NORDSTROM INC & SUBSIDIARIES
Other - Org Name:NORDSTROM INC
Other - Org Type:Other Name
Authorized Official - Title/Position:PROSTHESIS OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:KRESHA
Authorized Official - Middle Name:B
Authorized Official - Last Name:BRITTON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:206-454-4060
Mailing Address - Street 1:1617 6TH AVE
Mailing Address - Street 2:ATTN: PROSTHESIS
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98101-1707
Mailing Address - Country:US
Mailing Address - Phone:206-454-4060
Mailing Address - Fax:206-454-1279
Practice Address - Street 1:4321 LA JOLLA VILLAGE DR
Practice Address - Street 2:
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92122-1201
Practice Address - Country:US
Practice Address - Phone:858-457-4575
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-15
Last Update Date:2015-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes335E00000XSuppliersProsthetic/Orthotic Supplier
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA0435530036Medicare NSC