Healthcare Provider Details

I. General information

NPI: 1679608491
Provider Name (Legal Business Name): SUSAN TALLMADGE CARR ND
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/22/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1605 116TH AVE NE STE 104
BELLEVUE WA
98004-3034
US

IV. Provider business mailing address

1605 116TH AVE NE STE 104
BELLEVUE WA
98004-3034
US

V. Phone/Fax

Practice location:
  • Phone: 425-454-0787
  • Fax: 425-454-7827
Mailing address:
  • Phone: 425-454-0787
  • Fax: 425-454-7827

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code175F00000X
TaxonomyNaturopath
License NumberNT00001477
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: