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NPI Code Detail

MEDICARE: DR. PETRA ELENA EICHELSDOERFER RPH, MS, ND

MEDICARE:  DR. PETRA ELENA EICHELSDOERFER  RPH, MS, ND
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1133N00000XNutritionistNU00002095WA
2175F00000XNaturopathNT00001260WA
31835P0018XPharmacist Clinician (PhC)/ Clinical Pharmacy SpecialistPH 00014598WA

General Provider Information

NPI Number : 1770885089
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. PETRA ELENA EICHELSDOERFER RPH, MS, ND
Provider Business Mailing Address
First Line : 707 S GRADY WAY STE 600
Second Line :
City : RENTON
State : WA
Zip : 98057-3227
Country : US
Telephone Number : 952-251-5529
Fax Number : 877-787-5190
Provider Business Practice Location Address
First Line : 707 S GRADY WAY STE 600
Second Line :
City : RENTON
State : WA
Zip : 98057-3227
Country : US
Telephone Number : 952-251-5529
Fax Number : 877-787-5190
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 11/19/2010
Last Update Date : 09/12/2024

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Directions to “ DR. PETRA ELENA EICHELSDOERFER RPH, MS, ND” Practice Location

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