Healthcare Provider Details

I. General information

NPI: 1881680627
Provider Name (Legal Business Name): MONAWAR T. FAHOUM N.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 09/27/2005
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5312 ROOSEVELT WAY NE
SEATTLE WA
98105-3629
US

IV. Provider business mailing address

5312 ROOSEVELT WAY NE
SEATTLE WA
98105-3629
US

V. Phone/Fax

Practice location:
  • Phone: 206-525-8015
  • Fax: 206-525-8014
Mailing address:
  • Phone: 206-525-8015
  • Fax: 206-525-8014

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code175F00000X
TaxonomyNaturopath
License NumberNT00001300
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: