Healthcare Provider Details

I. General information

NPI: 1548957780
Provider Name (Legal Business Name): VIOME LIFE SCIENCES INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/19/2023
Last Update Date: 04/19/2023
Certification Date: 04/19/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11724 NE 195TH ST
BOTHELL WA
98011-3568
US

IV. Provider business mailing address

11724 NE 195TH ST
BOTHELL WA
98011-3568
US

V. Phone/Fax

Practice location:
  • Phone: 518-353-8766
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code291U00000X
TaxonomyClinical Medical Laboratory
License Number
License Number State

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name: JOHN BLANCHARD
Title or Position: COO
Credential:
Phone: 425-372-6718