Healthcare Provider Details

I. General information

NPI: 1710714365
Provider Name (Legal Business Name): FAUNTLEROY NATUROPATHIC MEDICINE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/17/2024
Last Update Date: 09/17/2024
Certification Date: 09/17/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12032 3RD AVE NE
SEATTLE WA
98125-4728
US

IV. Provider business mailing address

12032 3RD AVE NE
SEATTLE WA
98125-4728
US

V. Phone/Fax

Practice location:
  • Phone: 406-552-2927
  • Fax: 800-776-2339
Mailing address:
  • Phone: 406-552-2927
  • Fax: 800-776-2339

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code175F00000X
TaxonomyNaturopath
License Number
License Number State

VIII. Authorized Official

Name: JASON MICHAEL FAUNTLEROY
Title or Position: PHYSICIAN OWNER
Credential: ND
Phone: 406-552-2927