Provider Demographics
NPI:1639219587
Name:NIEDERMEYER, MOLLY ANNE (ND)
Entity Type:Individual
Prefix:DR
First Name:MOLLY
Middle Name:ANNE
Last Name:NIEDERMEYER
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 1:1409 NW 85TH ST
Mailing Address - Street 2:
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98117-4237
Mailing Address - Country:US
Mailing Address - Phone:206-781-2206
Mailing Address - Fax:206-783-3949
Practice Address - Street 1:1409 NW 85TH ST
Practice Address - Street 2:
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98117-4237
Practice Address - Country:US
Practice Address - Phone:206-781-2206
Practice Address - Fax:206-783-3949
Is Sole Proprietor?:No
Enumeration Date:2007-02-08
Last Update Date:2012-05-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WANT00000459175F00000X
WAMW00000058176B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes175F00000XOther Service ProvidersNaturopath
No176B00000XOther Service ProvidersMidwife
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA602379701Medicare UPIN