Healthcare Provider Details

I. General information

NPI: 1487923835
Provider Name (Legal Business Name): CHELSEA RAE HOLZINGER GORDON N.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/14/2011
Last Update Date: 07/18/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10315 19TH AVE SE
EVERETT WA
98208-4268
US

IV. Provider business mailing address

PO BOX 14577
MILL CREEK WA
98082-2577
US

V. Phone/Fax

Practice location:
  • Phone: 425-286-8803
  • Fax: 866-394-3445
Mailing address:
  • Phone: 425-286-8803
  • Fax: 866-394-3445

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code175F00000X
TaxonomyNaturopath
License NumberNT60255395
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: