Healthcare Provider Details

I. General information

NPI: 1962770396
Provider Name (Legal Business Name): INNATE HEALTH AWARENESS LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/13/2011
Last Update Date: 12/13/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

420 5TH AVE S SUITE 103
EDMONDS WA
98020-3464
US

IV. Provider business mailing address

420 5TH AVE S SUITE 103
EDMONDS WA
98020-3464
US

V. Phone/Fax

Practice location:
  • Phone: 206-618-6099
  • Fax:
Mailing address:
  • Phone: 206-618-6099
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171100000X
TaxonomyAcupuncturist
License NumberAC60175366
License Number StateWA
# 2
Primary TaxonomyN
Taxonomy Code174400000X
TaxonomySpecialist
License NumberMA00022731
License Number StateWA

VIII. Authorized Official

Name: NATALIE-PASCALE A BOISSEAU
Title or Position: OWNER
Credential: LAC EAMP, LMP
Phone: 206-618-6099