Provider Demographics
NPI:1770021008
Name:NORKUS, PETER AUSTIN (LSWAIC)
Entity Type:Individual
Prefix:
First Name:PETER
Middle Name:AUSTIN
Last Name:NORKUS
Suffix:
Gender:M
Credentials:LSWAIC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:125 SW CAMPUS DR
Mailing Address - Street 2:APT 6-104
Mailing Address - City:FEDERAL WAY
Mailing Address - State:WA
Mailing Address - Zip Code:98023-8365
Mailing Address - Country:US
Mailing Address - Phone:616-558-6606
Mailing Address - Fax:
Practice Address - Street 1:1700 WESTLAKE AVE N
Practice Address - Street 2:SUITE 700
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98109-3012
Practice Address - Country:US
Practice Address - Phone:206-283-2220
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-02-07
Last Update Date:2017-02-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WASC 60635149390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program