Healthcare Provider Details

I. General information

NPI: 1396222691
Provider Name (Legal Business Name): SAMANTHA ROSE GUTHRIE ND, LAC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/19/2018
Last Update Date: 05/05/2021
Certification Date: 05/05/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1215 4TH AVE STE 1000
SEATTLE WA
98161-1017
US

IV. Provider business mailing address

1215 4TH AVE STE 1000
SEATTLE WA
98161-1017
US

V. Phone/Fax

Practice location:
  • Phone: 206-622-9001
  • Fax: 206-622-4311
Mailing address:
  • Phone: 206-622-9001
  • Fax: 206-622-4311

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code175F00000X
TaxonomyNaturopath
License NumberNT60892736
License Number StateWA
# 2
Primary TaxonomyN
Taxonomy Code171100000X
TaxonomyAcupuncturist
License NumberAC60901212
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: