Healthcare Provider Details

I. General information

NPI: 1013268622
Provider Name (Legal Business Name): ONE SKY FAMILY MEDICINE, PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/21/2012
Last Update Date: 10/14/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6327 22ND AVE NE
SEATTLE WA
98115-6919
US

IV. Provider business mailing address

6327 22ND AVE NE
SEATTLE WA
98115-6919
US

V. Phone/Fax

Practice location:
  • Phone: 206-363-5555
  • Fax: 206-363-5533
Mailing address:
  • Phone: 206-363-5555
  • Fax: 206-363-5533

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code175F00000X
TaxonomyNaturopath
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number State

VIII. Authorized Official

Name: TRACY S MCDANIEL
Title or Position: MANAGING MEMBER
Credential: ND
Phone: 206-363-5555