Healthcare Provider Details

I. General information

NPI: 1093965154
Provider Name (Legal Business Name): CHENELLE A ROBERTS ND, LM
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/25/2008
Last Update Date: 09/25/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5343 TALLMAN AVE NW STE 100
SEATTLE WA
98107-3940
US

IV. Provider business mailing address

5343 TALLMAN AVE NW STE 100
SEATTLE WA
98107-3940
US

V. Phone/Fax

Practice location:
  • Phone: 206-706-0306
  • Fax: 206-706-4772
Mailing address:
  • Phone: 206-706-0306
  • Fax: 206-706-4772

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code175F00000X
TaxonomyNaturopath
License NumberNT00001436
License Number StateWA
# 2
Primary TaxonomyN
Taxonomy Code176B00000X
TaxonomyMidwife
License NumberMW00000303
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: