Healthcare Provider Details

I. General information

NPI: 1104234533
Provider Name (Legal Business Name): ACTUAL WELLNESS LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/29/2014
Last Update Date: 07/29/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1512 NE 70TH ST
SEATTLE WA
98115-5745
US

IV. Provider business mailing address

1512 NE 70TH ST
SEATTLE WA
98115-5745
US

V. Phone/Fax

Practice location:
  • Phone: 360-320-6772
  • Fax: 425-526-5659
Mailing address:
  • Phone: 360-320-6772
  • Fax: 425-526-5659

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code133N00000X
TaxonomyNutritionist
License NumberNUTR.NU.60316605
License Number StateWA

VIII. Authorized Official

Name: HANNAH EPSTEIN
Title or Position: CERTIFIED NUTRITIONIST/OWNER
Credential: MS
Phone: 360-320-6772