Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 175F00000X | Naturopath | NT61006682 | WA |
NPI | 1073155412 |
---|---|
Provider Name | Lauren Alixandra Gresham |
First Address | Shoreline, WA 98133-3213 |
Second Address | Shoreline, WA 98133-3213 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 16/10/2019 |
Last Update Date | 16/10/2019 |