Provider Demographics
NPI:1679824718
Name:ANDERSON, NICOLE M (ND, LMP)
Entity Type:Individual
Prefix:DR
First Name:NICOLE
Middle Name:M
Last Name:ANDERSON
Suffix:
Gender:F
Credentials:ND, LMP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 82765
Mailing Address - Street 2:
Mailing Address - City:KENMORE
Mailing Address - State:WA
Mailing Address - Zip Code:98028-0765
Mailing Address - Country:US
Mailing Address - Phone:425-429-2334
Mailing Address - Fax:425-483-7332
Practice Address - Street 1:16923 96TH AVE NE
Practice Address - Street 2:
Practice Address - City:BOTHELL
Practice Address - State:WA
Practice Address - Zip Code:98011-1937
Practice Address - Country:US
Practice Address - Phone:425-429-2334
Practice Address - Fax:425-483-7332
Is Sole Proprietor?:No
Enumeration Date:2012-09-28
Last Update Date:2014-01-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMA60129767225700000X
WANT 60313732175F00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes175F00000XOther Service ProvidersNaturopath
No225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist