Provider Demographics
NPI:1063729952
Name:NORTHWEST VEIN & AESTHETIC CENTER
Entity type:Organization
Organization Name:NORTHWEST VEIN & AESTHETIC CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:M.D.
Authorized Official - Prefix:DR
Authorized Official - First Name:AKSEL
Authorized Official - Middle Name:
Authorized Official - Last Name:NORDESTGAARD
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:253-857-8346
Mailing Address - Street 1:4700 POINT FOSDICK DR NW STE 307
Mailing Address - Street 2:
Mailing Address - City:GIG HARBOR
Mailing Address - State:WA
Mailing Address - Zip Code:98335-1706
Mailing Address - Country:US
Mailing Address - Phone:253-857-8346
Mailing Address - Fax:
Practice Address - Street 1:4700 POINT FOSDICK DR NW STE 307
Practice Address - Street 2:
Practice Address - City:GIG HARBOR
Practice Address - State:WA
Practice Address - Zip Code:98335-1706
Practice Address - Country:US
Practice Address - Phone:253-857-8346
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-09-13
Last Update Date:2010-09-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Single Specialty