Healthcare Provider Details

I. General information

NPI: 1871036152
Provider Name (Legal Business Name): JASMINE MILLER CN, MSHNFM
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/18/2016
Last Update Date: 10/25/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

904 7TH AVE 9TH FLOOR, SUITE C
SEATTLE WA
98104-1132
US

IV. Provider business mailing address

904 7TH AVE 9TH FLOOR, SUITE C
SEATTLE WA
98104-1132
US

V. Phone/Fax

Practice location:
  • Phone: 206-860-5499
  • Fax:
Mailing address:
  • Phone: 206-860-5499
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code133NN1002X
TaxonomyNutrition Education Nutritionist
License NumberNU60683517
License Number StateWA
# 2
Primary TaxonomyY
Taxonomy Code133N00000X
TaxonomyNutritionist
License NumberNU 60683517
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: