Provider Demographics
NPI:1912019621
Name:DEMETRO, ALEXANDRA KATHERINE (ND, LM)
Entity Type:Individual
Prefix:
First Name:ALEXANDRA
Middle Name:KATHERINE
Last Name:DEMETRO
Suffix:
Gender:F
Credentials:ND, LM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:404 E MAIN ST
Mailing Address - Street 2:
Mailing Address - City:BATTLE GROUND
Mailing Address - State:WA
Mailing Address - Zip Code:98604
Mailing Address - Country:US
Mailing Address - Phone:360-687-0800
Mailing Address - Fax:360-687-1600
Practice Address - Street 1:404 E MAIN ST
Practice Address - Street 2:
Practice Address - City:BATTLE GROUND
Practice Address - State:WA
Practice Address - Zip Code:98604
Practice Address - Country:US
Practice Address - Phone:360-687-0800
Practice Address - Fax:360-687-1600
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-31
Last Update Date:2018-07-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR1264175F00000X
WAMW60259967176B00000X
WANT60254488175F00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes175F00000XOther Service ProvidersNaturopath
No176B00000XOther Service ProvidersMidwife
Provider Identifiers
StateIdentifier IDID TypeIssuer
NT 60254488OtherND WASHINGTON LICENSE NUMBER
1264OtherND OREGON LICENSE NUMBER