Healthcare Provider Details

I. General information

NPI: 1083994008
Provider Name (Legal Business Name): GABRIELLE LYNN ANDERSON L.AC., EAMP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/22/2011
Last Update Date: 08/22/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4915 25TH AVE NE SUITE 104 WEST
SEATTLE WA
98105-5667
US

IV. Provider business mailing address

3045 CALIFORNIA AVE SW
SEATTLE WA
98116-3301
US

V. Phone/Fax

Practice location:
  • Phone: 206-315-7998
  • Fax: 206-316-2308
Mailing address:
  • Phone: 360-420-2852
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171100000X
TaxonomyAcupuncturist
License NumberAC60134539
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: