1073989307 NPI number — NAMASTE NUTRITIONIST

Table of content: (NPI 1073989307)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1073989307 NPI number — NAMASTE NUTRITIONIST

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
NAMASTE NUTRITIONIST
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
NAMASTE NUTRITIONIST, PLLC
Provider Other Organization Name Type Code:
3
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1073989307
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
12/23/2022
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1523 132ND ST SE STE C
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
EVERETT
Provider Business Mailing Address State Name:
WA
Provider Business Mailing Address Postal Code:
98208-7200
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
206-486-5108
Provider Business Mailing Address Fax Number:
206-331-4193

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2202 64TH AVE WE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
MOUNT LAKE TERRACE
Provider Business Practice Location Address State Name:
WA
Provider Business Practice Location Address Postal Code:
98043
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
206-486-5108
Provider Business Practice Location Address Fax Number:
206-331-4193
Provider Enumeration Date:
08/21/2015

Additional Information

Authorized Official

Authorized Official Last Name:
ARNOLD
Authorized Official First Name:
FRANCES
Authorized Official Middle Name:
L
Authorized Official Title or Position:
CEO, RDN
Authorized Official Telephone Number:
206-486-5108

Provider Taxonomy Codes

  • Taxonomy code: 133V00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 261QH0100X , with the licence number: 60252564 , registered in the state of WA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 1053652032 . This is a "NPI" identifier , issued by the state of ( WA ) . This identifiers is of the category "OTHER".
  • Identifier: 1073989307 . This is a "GROUP NPI" identifier , issued by the state of ( WA ) . This identifiers is of the category "OTHER".




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