Healthcare Provider Details

I. General information

NPI: 1821549692
Provider Name (Legal Business Name): TUMMY TEMPLE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/17/2016
Last Update Date: 10/17/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2016 NE 65TH ST SUITE B
SEATTLE WA
98115-6957
US

IV. Provider business mailing address

2016 NE 65TH ST SUITE B
SEATTLE WA
98115-6957
US

V. Phone/Fax

Practice location:
  • Phone: 206-527-6127
  • Fax:
Mailing address:
  • Phone: 206-527-6127
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code133V00000X
TaxonomyRegistered Dietitian
License NumberRD1020427
License Number StateWA
# 2
Primary TaxonomyN
Taxonomy Code171100000X
TaxonomyAcupuncturist
License NumberACUP.AC.60672521
License Number StateWA
# 3
Primary TaxonomyN
Taxonomy Code175F00000X
TaxonomyNaturopath
License NumberNT00001172
License Number StateWA
# 4
Primary TaxonomyN
Taxonomy Code175L00000X
TaxonomyHomeopath
License Number
License Number State
# 5
Primary TaxonomyY
Taxonomy Code175F00000X
TaxonomyNaturopath
License NumberNT60258519
License Number StateWA

VIII. Authorized Official

Name: TIM ZIMMER
Title or Position: CO-OWNER
Credential:
Phone: 207-527-6127