Individual
MARTIN IVERSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
927 E FAIRHAVEN AVE, BURLINGTON, WA 98233-1918
(360) 757-3311
Mailing address
927 E FAIRHAVEN AVE, BURLINGTON, WA 98233-1918
(360) 757-3311
Taxonomy
Speciality
Code
Description
License number
State
251300000X
Local Education Agency (LEA)
Primary
P160045845
WA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
251300000X
—
WA
Enumeration date
10/24/2014
Last updated
10/24/2014
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