Healthcare Provider Details

I. General information

NPI: 1992062368
Provider Name (Legal Business Name): COMPREHENSIVE NATURAL MEDICINE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/23/2012
Last Update Date: 12/10/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11821 NE 128TH STREET, SUITE H
KIRKLAND WA
98034
US

IV. Provider business mailing address

11821 NE 128TH STREET, SUITE H
KIRKLAND WA
98034
US

V. Phone/Fax

Practice location:
  • Phone: 206-618-6549
  • Fax:
Mailing address:
  • Phone: 425-896-8891
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code261QM2500X
TaxonomyMedical Specialty Clinic/Center
License NumberAC60252797
License Number StateWA
# 2
Primary TaxonomyY
Taxonomy Code261QP2300X
TaxonomyPrimary Care Clinic/Center
License NumberNT60242287
License Number StateWA

VIII. Authorized Official

Name: MS. JENNIFER A. BLASI
Title or Position: OWNER
Credential: ND, LAC
Phone: 206-618-6549