Provider Demographics
NPI:1023350055
Name:VIRIDITAS NATUROPATHIC MEDICINE, PLLC
Entity type:Organization
Organization Name:VIRIDITAS NATUROPATHIC MEDICINE, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:ANNA
Authorized Official - Middle Name:IRENE
Authorized Official - Last Name:WIEMAN
Authorized Official - Suffix:
Authorized Official - Credentials:ND
Authorized Official - Phone:509-427-3624
Mailing Address - Street 1:27 SW RUSSELL AVE.
Mailing Address - Street 2:P.O. BOX 1457
Mailing Address - City:STEVENSON
Mailing Address - State:WA
Mailing Address - Zip Code:98648-1457
Mailing Address - Country:US
Mailing Address - Phone:509-427-3624
Mailing Address - Fax:
Practice Address - Street 1:27 SW RUSSELL AVE.
Practice Address - Street 2:
Practice Address - City:STEVENSON
Practice Address - State:WA
Practice Address - Zip Code:98648-1457
Practice Address - Country:US
Practice Address - Phone:509-427-3624
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-03-15
Last Update Date:2013-03-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WANT60319044175F00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes175F00000XOther Service ProvidersNaturopathGroup - Single Specialty