Provider Demographics
NPI:1427112200
Name:REWERTS, BRIAN DEAN (ND)
Entity type:Individual
Prefix:
First Name:BRIAN
Middle Name:DEAN
Last Name:REWERTS
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 1:1299 156TH AVE NE STE 123
Mailing Address - Street 2:
Mailing Address - City:BELLEVUE
Mailing Address - State:WA
Mailing Address - Zip Code:98007-7562
Mailing Address - Country:US
Mailing Address - Phone:425-614-4000
Mailing Address - Fax:425-641-0880
Practice Address - Street 1:1299 156TH AVE NE STE 123
Practice Address - Street 2:
Practice Address - City:BELLEVUE
Practice Address - State:WA
Practice Address - Zip Code:98007-7562
Practice Address - Country:US
Practice Address - Phone:425-614-4000
Practice Address - Fax:425-641-0880
Is Sole Proprietor?:No
Enumeration Date:2006-12-19
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WANT00001283175F00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes175F00000XOther Service ProvidersNaturopath
Provider Identifiers
StateIdentifier IDID TypeIssuer
WANT00001283OtherLICENSE