Healthcare Provider Details

I. General information

NPI: 1285087502
Provider Name (Legal Business Name): NICOLE SEPIEDEH ESKANDARI MS LAC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/21/2016
Last Update Date: 07/21/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2711 14TH AVE S A
SEATTLE WA
98144-5098
US

IV. Provider business mailing address

2711 14TH AVE S A
SEATTLE WA
98144-5098
US

V. Phone/Fax

Practice location:
  • Phone: 602-369-4667
  • Fax:
Mailing address:
  • Phone: 602-369-4667
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171100000X
TaxonomyAcupuncturist
License NumberAC60653216
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: