Healthcare Provider Details

I. General information

NPI: 1194119990
Provider Name (Legal Business Name): ANNIE THOE LMP, GCFP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/19/2015
Last Update Date: 03/19/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6921 ROOSEVELT WAY NE
SEATTLE WA
98115-6634
US

IV. Provider business mailing address

2201 NE 120TH ST
SEATTLE WA
98125-5254
US

V. Phone/Fax

Practice location:
  • Phone: 206-271-4270
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174H00000X
TaxonomyHealth Educator
License NumberMA00003343
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: