Provider Demographics
NPI:1740401801
Name:POURNADEALI, KASRA (ND)
Entity type:Individual
Prefix:DR
First Name:KASRA
Middle Name:
Last Name:POURNADEALI
Suffix:
Gender:M
Credentials:ND
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:316 STATE AVE
Mailing Address - Street 2:
Mailing Address - City:MARYSVILLE
Mailing Address - State:WA
Mailing Address - Zip Code:98270-5028
Mailing Address - Country:US
Mailing Address - Phone:360-651-9355
Mailing Address - Fax:
Practice Address - Street 1:316 STATE AVE
Practice Address - Street 2:
Practice Address - City:MARYSVILLE
Practice Address - State:WA
Practice Address - Zip Code:98270-5028
Practice Address - Country:US
Practice Address - Phone:360-651-9355
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-05-02
Last Update Date:2011-12-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WANT865175F00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes175F00000XOther Service ProvidersNaturopath