Provider Demographics
NPI:1063622462
Name:SCURICH, NATE (LMT)
Entity type:Individual
Prefix:
First Name:NATE
Middle Name:
Last Name:SCURICH
Suffix:
Gender:M
Credentials:LMT
Other - Prefix:MR
Other - First Name:NATHANIEL
Other - Middle Name:
Other - Last Name:SCURICH
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:LMT
Mailing Address - Street 1:1425 BROADWAY
Mailing Address - Street 2:25
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98122-3854
Mailing Address - Country:US
Mailing Address - Phone:206-226-2588
Mailing Address - Fax:206-860-6092
Practice Address - Street 1:3221 EASTLAKE AVE E
Practice Address - Street 2:#110
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98102-7125
Practice Address - Country:US
Practice Address - Phone:206-226-2588
Practice Address - Fax:206-860-6092
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-23
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMA00009837174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist