Healthcare Provider Details

I. General information

NPI: 1629378997
Provider Name (Legal Business Name): SEATTLE HOLISTIC CENTER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/02/2010
Last Update Date: 11/02/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4649 SUNNYSIDE AVE N STE#302
SEATTLE WA
98103-6900
US

IV. Provider business mailing address

4649 SUNNYSIDE AVE N STE#302
SEATTLE WA
98103-6900
US

V. Phone/Fax

Practice location:
  • Phone: 206-525-9035
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WP1700X
TaxonomyPerinatal Registered Nurse
License Number00092091
License Number StateWA

VIII. Authorized Official

Name: COLETTE CRAWFORD
Title or Position: PRESIDENT
Credential: RN, BSN
Phone: 206-525-9035