Healthcare Provider Details

I. General information

NPI: 1679691166
Provider Name (Legal Business Name): LINDA LISE-MARIE DAGENAIS N.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/26/2007
Last Update Date: 06/22/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5600 KIRKWOOD PL N STE A
SEATTLE WA
98103-5964
US

IV. Provider business mailing address

5600 KIRKWOOD PL N STE A
SEATTLE WA
98103-5964
US

V. Phone/Fax

Practice location:
  • Phone: 206-903-6111
  • Fax: 206-903-6125
Mailing address:
  • Phone: 206-841-0588
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code175F00000X
TaxonomyNaturopath
License NumberNT948
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: