Provider Demographics
NPI:1053596981
Name:SOVRAN, VIVIAN LUCIANA (ND)
Entity type:Individual
Prefix:DR
First Name:VIVIAN
Middle Name:LUCIANA
Last Name:SOVRAN
Suffix:
Gender:F
Credentials:ND
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12911 120TH AVE NE
Mailing Address - Street 2:SUITE E-50
Mailing Address - City:KIRKLAND
Mailing Address - State:WA
Mailing Address - Zip Code:98034-3027
Mailing Address - Country:US
Mailing Address - Phone:425-820-7700
Mailing Address - Fax:425-820-7707
Practice Address - Street 1:12911 120TH AVE NE
Practice Address - Street 2:SUITE E-50
Practice Address - City:KIRKLAND
Practice Address - State:WA
Practice Address - Zip Code:98034-3027
Practice Address - Country:US
Practice Address - Phone:425-820-7700
Practice Address - Fax:425-820-7707
Is Sole Proprietor?:No
Enumeration Date:2008-01-09
Last Update Date:2008-01-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WANT00001595175F00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes175F00000XOther Service ProvidersNaturopath