Provider Demographics
NPI:1629113303
Name:ANDERSON, PAUL STANLEY (ND)
Entity Type:Individual
Prefix:DR
First Name:PAUL
Middle Name:STANLEY
Last Name:ANDERSON
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 1:2150 N. 107TH ST.
Mailing Address - Street 2:SUITE 400
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98133-9009
Mailing Address - Country:US
Mailing Address - Phone:206-629-2186
Mailing Address - Fax:206-420-8393
Practice Address - Street 1:2150 N. 107TH ST
Practice Address - Street 2:SUITE 400
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98133-9009
Practice Address - Country:US
Practice Address - Phone:206-629-2186
Practice Address - Fax:206-420-8393
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-21
Last Update Date:2014-08-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WANT00001504175F00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes175F00000XOther Service ProvidersNaturopath