Provider Demographics
NPI:1396888541
Name:EVERGREEN NATUROPATHIC
Entity type:Organization
Organization Name:EVERGREEN NATUROPATHIC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:ALYCIA
Authorized Official - Middle Name:RENEE
Authorized Official - Last Name:POLICANI
Authorized Official - Suffix:
Authorized Official - Credentials:ND
Authorized Official - Phone:509-755-5100
Mailing Address - Street 1:1801 W. BROADWAY AVE
Mailing Address - Street 2:SUITE 2
Mailing Address - City:SPOKANE
Mailing Address - State:WA
Mailing Address - Zip Code:99201
Mailing Address - Country:US
Mailing Address - Phone:509-755-5100
Mailing Address - Fax:509-747-6646
Practice Address - Street 1:1801 W. BROADWAY AVE
Practice Address - Street 2:SUITE 2
Practice Address - City:SPOKANE
Practice Address - State:WA
Practice Address - Zip Code:99201
Practice Address - Country:US
Practice Address - Phone:509-755-5100
Practice Address - Fax:509-747-6646
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-15
Last Update Date:2022-03-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WANT00001028175F00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes175F00000XOther Service ProvidersNaturopathGroup - Single Specialty