Healthcare Provider Details

I. General information

NPI: 1265024640
Provider Name (Legal Business Name): NATALY ELLA NISLOW CNS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/08/2021
Last Update Date: 12/16/2025
Certification Date: 12/16/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

13813 88TH AVE NE
KIRKLAND WA
98034-1769
US

IV. Provider business mailing address

13813 88TH AVE NE
KIRKLAND WA
98034-1769
US

V. Phone/Fax

Practice location:
  • Phone: 410-236-5832
  • Fax:
Mailing address:
  • Phone: 410-236-5832
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code133N00000X
TaxonomyNutritionist
License Number61104713
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: