Provider Demographics
NPI:1982732368
Name:DEICHERT, DAVID (ND, ARNP)
Entity Type:Individual
Prefix:DR
First Name:DAVID
Middle Name:
Last Name:DEICHERT
Suffix:
Gender:M
Credentials:ND, ARNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:20624 SE 119TH ST
Mailing Address - Street 2:
Mailing Address - City:ISSAQUAH
Mailing Address - State:WA
Mailing Address - Zip Code:98027-5402
Mailing Address - Country:US
Mailing Address - Phone:206-795-5760
Mailing Address - Fax:
Practice Address - Street 1:12600 SE 38TH ST STE 130
Practice Address - Street 2:
Practice Address - City:BELLEVUE
Practice Address - State:WA
Practice Address - Zip Code:98006-6105
Practice Address - Country:US
Practice Address - Phone:425-679-6056
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-28
Last Update Date:2019-01-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WANT00001426175F00000X
WAAP60178142363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No175F00000XOther Service ProvidersNaturopath