Provider Demographics
NPI:1548289069
Name:NORD, MICHAEL (NAVY IDC)
Entity type:Individual
Prefix:MR
First Name:MICHAEL
Middle Name:
Last Name:NORD
Suffix:
Gender:M
Credentials:NAVY IDC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7481 BRIDLEVALE BLVD NW
Mailing Address - Street 2:
Mailing Address - City:BREMERTON
Mailing Address - State:WA
Mailing Address - Zip Code:98311-8987
Mailing Address - Country:US
Mailing Address - Phone:360-649-7501
Mailing Address - Fax:360-396-4247
Practice Address - Street 1:7481 BRIDLEVALE BLVD NW
Practice Address - Street 2:
Practice Address - City:BREMERTON
Practice Address - State:WA
Practice Address - Zip Code:98311-8987
Practice Address - Country:US
Practice Address - Phone:360-315-4208
Practice Address - Fax:360-396-4247
Is Sole Proprietor?:No
Enumeration Date:2006-07-18
Last Update Date:2007-12-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA1710I1002X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1710I1002XOther Service ProvidersMilitary Health Care ProviderIndependent Duty Corpsman