Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 175F00000X | Naturopath | 4059 | OR |
NPI | 1114449667 |
---|---|
Provider Name | Nicolette Callan |
First Address | Seattle, WA 98105-5218 |
Second Address | Seattle, WA 98105-5218 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 15/07/2017 |
Last Update Date | 15/07/2017 |