Provider Demographics
NPI:1821214651
Name:DERKSEN, AMY MAY (ND)
Entity Type:Individual
Prefix:DR
First Name:AMY
Middle Name:MAY
Last Name:DERKSEN
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 1:19217 36TH AVE W.
Mailing Address - Street 2:BLDG 5, SUITE 106
Mailing Address - City:LYNWOOD
Mailing Address - State:WA
Mailing Address - Zip Code:98036
Mailing Address - Country:US
Mailing Address - Phone:425-582-7678
Mailing Address - Fax:425-582-7032
Practice Address - Street 1:19217 36TH AVE W.
Practice Address - Street 2:BLDG 5, SUITE 106
Practice Address - City:LYNWOOD
Practice Address - State:WA
Practice Address - Zip Code:98036
Practice Address - Country:US
Practice Address - Phone:425-582-7678
Practice Address - Fax:425-582-7032
Is Sole Proprietor?:No
Enumeration Date:2007-04-18
Last Update Date:2019-11-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WANT00001250175F00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes175F00000XOther Service ProvidersNaturopath