Healthcare Provider Details

I. General information

NPI: 1811290372
Provider Name (Legal Business Name): ASHLEY RENEE LANDBLOOM ND, LAC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/06/2010
Last Update Date: 12/22/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3876 BRIDGE WAY N SUITE 300
SEATTLE WA
98103-7951
US

IV. Provider business mailing address

3876 BRIDGE WAY N SUITE 300
SEATTLE WA
98103-7951
US

V. Phone/Fax

Practice location:
  • Phone: 206-624-6677
  • Fax: 206-525-5933
Mailing address:
  • Phone: 206-624-6677
  • Fax: 206-525-5933

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code175F00000X
TaxonomyNaturopath
License NumberNT60186069
License Number StateWA
# 2
Primary TaxonomyN
Taxonomy Code171100000X
TaxonomyAcupuncturist
License NumberAC60202398
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: