Healthcare Provider Details

I. General information

NPI: 1548791957
Provider Name (Legal Business Name): ERIN SEKULICH
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/27/2017
Last Update Date: 07/17/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2111 N NORTHGATE WAY STE 201
SEATTLE WA
98133
US

IV. Provider business mailing address

105 NE 56TH ST
SEATTLE WA
98105-3737
US

V. Phone/Fax

Practice location:
  • Phone: 206-525-8015
  • Fax: 206-525-8014
Mailing address:
  • Phone: 206-632-5662
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code133N00000X
TaxonomyNutritionist
License NumberNU00001465
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: