Healthcare Provider Details

I. General information

NPI: 1790882645
Provider Name (Legal Business Name): REBECCA M. RISLEY N.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: MANDY RISLEY N.D.

II. Dates (important events)

Enumeration Date: 09/20/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

726 BROADWAY SUITE 301
SEATTLE WA
98122-4378
US

IV. Provider business mailing address

1610 24TH AVE
SEATTLE WA
98122-3011
US

V. Phone/Fax

Practice location:
  • Phone: 206-726-0034
  • Fax:
Mailing address:
  • Phone: 206-841-5537
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code175F00000X
TaxonomyNaturopath
License NumberNT00001470
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: