Healthcare Provider Details

I. General information

NPI: 1962737809
Provider Name (Legal Business Name): MIRANDA HOLLY MARTI N.D., L.AC.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/09/2009
Last Update Date: 07/21/2022
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12815 120TH AVE NE STE E
KIRKLAND WA
98034-3003
US

IV. Provider business mailing address

1135 116TH AVE NE STE 620
BELLEVUE WA
98004-4636
US

V. Phone/Fax

Practice location:
  • Phone: 425-398-9355
  • Fax: 425-453-2827
Mailing address:
  • Phone: 425-454-8016
  • Fax: 425-453-2827

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code171100000X
TaxonomyAcupuncturist
License NumberAC60105885
License Number StateWA
# 2
Primary TaxonomyY
Taxonomy Code175F00000X
TaxonomyNaturopath
License NumberNT60105841
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: