Healthcare Provider Details

I. General information

NPI: 1265152169
Provider Name (Legal Business Name): TUBMAN CENTER FOR HEALTH & FREEDOM
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/31/2022
Last Update Date: 09/01/2022
Certification Date: 09/01/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6020 RAINIER AVE S
SEATTLE WA
98118-2776
US

IV. Provider business mailing address

PO BOX 18612
SEATTLE WA
98118-0612
US

V. Phone/Fax

Practice location:
  • Phone: 206-702-8101
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163WP0807X
TaxonomyChild & Adolescent Psychiatric/Mental Health Registered Nurse
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code2080S0010X
TaxonomyPediatric Sports Medicine Physician
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code364SS0200X
TaxonomySchool Clinical Nurse Specialist
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code364SX0106X
TaxonomyOccupational Health Clinical Nurse Specialist
License Number
License Number State
# 5
Primary TaxonomyY
Taxonomy Code363LS0200X
TaxonomySchool Nurse Practitioner
License Number
License Number State

VIII. Authorized Official

Name: LAUREN BLACKHAM
Title or Position: NATUROPATHIC PHYSICIAN
Credential: NP
Phone: 206-702-8101