Healthcare Provider Details

I. General information

NPI: 1538274121
Provider Name (Legal Business Name): TERESA JANELLE JANSEN L.AC.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/21/2006
Last Update Date: 10/31/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1429 MARKET ST
KIRKLAND WA
98033-5432
US

IV. Provider business mailing address

9805 NE 116TH ST PMB #7249
KIRKLAND WA
98034-4245
US

V. Phone/Fax

Practice location:
  • Phone: 425-466-6071
  • Fax:
Mailing address:
  • Phone: 425-466-6071
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171100000X
TaxonomyAcupuncturist
License NumberAC00002436
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: