1689737330 NPI number — DOCERE CENTER FOR NATURAL MEDICINE

Table of content: (NPI 1689737330)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1689737330 NPI number — DOCERE CENTER FOR NATURAL MEDICINE

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
DOCERE CENTER FOR NATURAL MEDICINE
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:
Provider Other Organization Name Type Code:
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:
1689737330
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/22/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
5343 TALLMAN AVE NW
Provider Second Line Business Mailing Address:
STE 100
Provider Business Mailing Address City Name:
SEATTLE
Provider Business Mailing Address State Name:
WA
Provider Business Mailing Address Postal Code:
98107-3931
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
206-706-0306
Provider Business Mailing Address Fax Number:
206-706-4772

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
5343 TALLMAN AVE NW
Provider Second Line Business Practice Location Address:
STE 100
Provider Business Practice Location Address City Name:
SEATTLE
Provider Business Practice Location Address State Name:
WA
Provider Business Practice Location Address Postal Code:
98107-3931
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
206-706-0306
Provider Business Practice Location Address Fax Number:
206-706-4772
Provider Enumeration Date:
12/17/2006

Additional Information

Authorized Official

Authorized Official Last Name:
ROBERTS
Authorized Official First Name:
CHENELLE
Authorized Official Middle Name:
ANN
Authorized Official Title or Position:
CO-OWNER
Authorized Official Telephone Number:
206-706-0306

Provider Taxonomy Codes

  • Taxonomy code: 175F00000X , with the licence number:  NT00001436 , registered in the state of WA ; information, associated with the NPI states the following Primary Taxonomy Switch: "X" .
  • Taxonomy code: 176B00000X , with the licence number: MW00000303 , registered in the state of WA ; information, associated with the NPI states the following Primary Taxonomy Switch: "X" .

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

  • Identifier: 7131816 , issued by the state of ( WA ) . This identifiers is of the category "MEDICAID".




Copyright © 2007-2025 www.npivalidator.com