Provider Demographics
NPI:1730708330
Name:ANDERSEN, PETER (ND, LMT)
Entity type:Individual
Prefix:DR
First Name:PETER
Middle Name:
Last Name:ANDERSEN
Suffix:
Gender:M
Credentials:ND, LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1023 W FRANCIS AVE
Mailing Address - Street 2:
Mailing Address - City:SPOKANE
Mailing Address - State:WA
Mailing Address - Zip Code:99205-6669
Mailing Address - Country:US
Mailing Address - Phone:509-327-5143
Mailing Address - Fax:509-327-9813
Practice Address - Street 1:1023 W FRANCIS AVE
Practice Address - Street 2:
Practice Address - City:SPOKANE
Practice Address - State:WA
Practice Address - Zip Code:99205-6669
Practice Address - Country:US
Practice Address - Phone:509-327-5143
Practice Address - Fax:509-327-9813
Is Sole Proprietor?:No
Enumeration Date:2020-04-13
Last Update Date:2020-04-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA61016315175F00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes175F00000XOther Service ProvidersNaturopath