Provider Demographics
NPI:1972538536
Name:NORDSTROM
Entity Type:Organization
Organization Name:NORDSTROM
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PROSTHESIS OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:TRACY
Authorized Official - Middle Name:
Authorized Official - Last Name:CONDIE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:206-373-2047
Mailing Address - Street 1:1617 6TH AVE
Mailing Address - Street 2:
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98101-1707
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:50 S MAIN ST
Practice Address - Street 2:
Practice Address - City:SALT LAKE CITY
Practice Address - State:UT
Practice Address - Zip Code:84144-0103
Practice Address - Country:US
Practice Address - Phone:801-322-4200
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-12
Last Update Date:2008-04-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes335E00000XSuppliersProsthetic/Orthotic Supplier
Provider Identifiers
StateIdentifier IDID TypeIssuer
UT0435530009Medicare NSC