Healthcare Provider Details

I. General information

NPI: 1932664810
Provider Name (Legal Business Name): JASON H POOLER CN
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/05/2019
Last Update Date: 02/05/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2823 SW ADAMS ST UNIT C
SEATTLE WA
98126-2598
US

IV. Provider business mailing address

2823 SW ADAMS ST UNIT C
SEATTLE WA
98126-2598
US

V. Phone/Fax

Practice location:
  • Phone: 720-388-3485
  • Fax:
Mailing address:
  • Phone: 720-388-3485
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code133N00000X
TaxonomyNutritionist
License NumberNU60926852
License Number StateWA
# 2
Primary TaxonomyN
Taxonomy Code133NN1002X
TaxonomyNutrition Education Nutritionist
License NumberNU60926852
License Number StateWA
# 3
Primary TaxonomyN
Taxonomy Code2083P0901X
TaxonomyPublic Health & General Preventive Medicine Physician
License NumberNU60926852
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: