Provider Demographics
NPI:1114969847
Name:DISTANTE, MEREDITH JILL (ND)
Entity type:Individual
Prefix:DR
First Name:MEREDITH
Middle Name:JILL
Last Name:DISTANTE
Suffix:
Gender:F
Credentials:ND
Other - Prefix:
Other - First Name:MEREDITH
Other - Middle Name:
Other - Last Name:LERMAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:ND
Mailing Address - Street 1:415 NE BIRCH STREET
Mailing Address - Street 2:
Mailing Address - City:CAMAS
Mailing Address - State:WA
Mailing Address - Zip Code:98607
Mailing Address - Country:US
Mailing Address - Phone:360-834-2732
Mailing Address - Fax:360-834-3063
Practice Address - Street 1:415 NE BIRCH STREET
Practice Address - Street 2:
Practice Address - City:CAMAS
Practice Address - State:WA
Practice Address - Zip Code:98607
Practice Address - Country:US
Practice Address - Phone:360-834-2732
Practice Address - Fax:360-834-3063
Is Sole Proprietor?:No
Enumeration Date:2006-06-10
Last Update Date:2012-08-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WANT00001485175F00000X
OR1138175F00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes175F00000XOther Service ProvidersNaturopath
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR229268OtherOMAP PROVIDER NUMBER