Healthcare Provider Details

I. General information

NPI: 1831321850
Provider Name (Legal Business Name): NORTH SOUND CENTER FOR INTEGRATIVE MEDICINE PS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/10/2009
Last Update Date: 12/15/2020
Certification Date: 12/15/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

816 E FAIRHAVEN AVE
BURLINGTON WA
98233-1917
US

IV. Provider business mailing address

PO BOX 354
BURLINGTON WA
98233-0354
US

V. Phone/Fax

Practice location:
  • Phone: 360-336-0123
  • Fax: 360-336-0126
Mailing address:
  • Phone: 360-336-0123
  • Fax: 360-336-0126

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QP3300X
TaxonomyPain Clinic/Center
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code2083P0500X
TaxonomyPreventive Medicine/Occupational Environmental Medicine Physician
License NumberMD00035789
License Number StateWA

VIII. Authorized Official

Name: MARIAN ELAINE JOHNSTON
Title or Position: PHYSICIAN/PRESIDENT
Credential: M.D.
Phone: 360-336-0123