Provider Demographics
NPI:1437601937
Name:PETERSBURG, NATHAN (ND)
Entity type:Individual
Prefix:MR
First Name:NATHAN
Middle Name:
Last Name:PETERSBURG
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 1:7711 NE 175TH ST
Mailing Address - Street 2:C301
Mailing Address - City:KENMORE
Mailing Address - State:WA
Mailing Address - Zip Code:98028-3567
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:7711 NE 175TH ST
Practice Address - Street 2:C301
Practice Address - City:KENMORE
Practice Address - State:WA
Practice Address - Zip Code:98028-3567
Practice Address - Country:US
Practice Address - Phone:425-219-3853
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-10-31
Last Update Date:2018-09-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WANT60686734175F00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes175F00000XOther Service ProvidersNaturopath