Provider Demographics
NPI:1598270258
Name:BASILIERE, ERIC WAYNE (ND)
Entity Type:Individual
Prefix:DR
First Name:ERIC
Middle Name:WAYNE
Last Name:BASILIERE
Suffix:
Gender:M
Credentials:ND
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4520 INTELCO LOOP SE BLDG 3
Mailing Address - Street 2:
Mailing Address - City:LACEY
Mailing Address - State:WA
Mailing Address - Zip Code:98503-6008
Mailing Address - Country:US
Mailing Address - Phone:360-489-0429
Mailing Address - Fax:360-972-2526
Practice Address - Street 1:4520 INTELCO LOOP SE BLDG 3
Practice Address - Street 2:
Practice Address - City:LACEY
Practice Address - State:WA
Practice Address - Zip Code:98503-6008
Practice Address - Country:US
Practice Address - Phone:360-489-0429
Practice Address - Fax:360-972-2526
Is Sole Proprietor?:No
Enumeration Date:2017-12-04
Last Update Date:2021-06-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WANT60812682175F00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes175F00000XOther Service ProvidersNaturopath
Provider Identifiers
StateIdentifier IDID TypeIssuer
WANT60812682OtherNATUROPATHIC PHYSICIAN LICENSE