Provider Demographics
NPI:1750526885
Name:NEARY, DOMINIKA ZAJDEL (ND)
Entity type:Individual
Prefix:
First Name:DOMINIKA
Middle Name:ZAJDEL
Last Name:NEARY
Suffix:
Gender:F
Credentials:ND
Other - Prefix:
Other - First Name:DOMINIKA
Other - Middle Name:AGNIESZKA
Other - Last Name:ZAJDEL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:ND
Mailing Address - Street 1:PO BOX 1568
Mailing Address - Street 2:
Mailing Address - City:SULTAN
Mailing Address - State:WA
Mailing Address - Zip Code:98294-1568
Mailing Address - Country:US
Mailing Address - Phone:360-793-0206
Mailing Address - Fax:360-793-0214
Practice Address - Street 1:33405 STATE ROUTE 2
Practice Address - Street 2:
Practice Address - City:SULTAN
Practice Address - State:WA
Practice Address - Zip Code:98294-8607
Practice Address - Country:US
Practice Address - Phone:360-793-0206
Practice Address - Fax:360-793-0214
Is Sole Proprietor?:No
Enumeration Date:2008-12-03
Last Update Date:2018-12-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WANT60046584175F00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes175F00000XOther Service ProvidersNaturopath