Healthcare Provider Details

I. General information

NPI: 1508197468
Provider Name (Legal Business Name): NECTAR ACUPUNCTURE & INTEGRATED THERAPEUTICS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/15/2010
Last Update Date: 12/06/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

704 WARREN AVE N
SEATTLE WA
98109-4027
US

IV. Provider business mailing address

2808 HARRIS PL S
SEATTLE WA
98144-5924
US

V. Phone/Fax

Practice location:
  • Phone: 206-291-2810
  • Fax:
Mailing address:
  • Phone: 206-291-2810
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171100000X
TaxonomyAcupuncturist
License NumberAC60062789
License Number StateWA
# 2
Primary TaxonomyN
Taxonomy Code225700000X
TaxonomyMassage Therapist
License NumberMA00017680
License Number StateWA

VIII. Authorized Official

Name: MS. ALEXANDRA OLIVIA SOLLEK
Title or Position: LICENSED ACUPUNCTURIST AND MASSAGE
Credential: LAC., LMP
Phone: 206-291-2810