Healthcare Provider Details

I. General information

NPI: 1801050786
Provider Name (Legal Business Name): EMERALD CENTER FOR INTEGRATIVE MEDICINE LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/10/2008
Last Update Date: 04/29/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9730 3RD AVE NE SUITE 202
SEATTLE WA
98115-2023
US

IV. Provider business mailing address

PO BOX 78193
SEATTLE WA
98178-0193
US

V. Phone/Fax

Practice location:
  • Phone: 206-525-5576
  • Fax: 206-525-5776
Mailing address:
  • Phone: 206-772-5315
  • Fax: 206-774-8751

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code261QP2300X
TaxonomyPrimary Care Clinic/Center
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number
License Number StateNULL
# 3
Primary TaxonomyY
Taxonomy Code175F00000X
TaxonomyNaturopath
License Number
License Number StateNULL

VIII. Authorized Official

Name: MOIRA P FITZPATRICK
Title or Position: OWNER / PHYSICIAN
Credential: PHD, ND
Phone: 206-525-5576