Healthcare Provider Details

I. General information

NPI: 1376740878
Provider Name (Legal Business Name): EDGEWOOD NATURAL HEALTH, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/28/2007
Last Update Date: 03/08/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3217 MERIDIAN AVE E
EDGEWOOD WA
98371-2613
US

IV. Provider business mailing address

3217 MERIDIAN AVE E
EDGEWOOD WA
98371-2613
US

V. Phone/Fax

Practice location:
  • Phone: 253-927-5905
  • Fax: 253-321-0219
Mailing address:
  • Phone: 253-927-5905
  • Fax: 253-321-0219

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code225700000X
TaxonomyMassage Therapist
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code171100000X
TaxonomyAcupuncturist
License Number
License Number State

VIII. Authorized Official

Name: JOHN FROSTAD
Title or Position: OWNER
Credential:
Phone: 253-927-5905