Healthcare Provider Details

I. General information

NPI: 1831199330
Provider Name (Legal Business Name): LINDA REDMON MS, CN, LMP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: LINDA DAVIS

II. Dates (important events)

Enumeration Date: 07/26/2005
Last Update Date: 02/06/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

302 MAPLE AVE
SNOHOMISH WA
98290-2526
US

IV. Provider business mailing address

302 MAPLE AVE
SNOHOMISH WA
98290-2526
US

V. Phone/Fax

Practice location:
  • Phone: 360-568-3319
  • Fax: 360-568-5106
Mailing address:
  • Phone: 360-568-3319
  • Fax: 360-568-5106

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code133N00000X
TaxonomyNutritionist
License NumberNU00001735
License Number StateWA
# 2
Primary TaxonomyN
Taxonomy Code225700000X
TaxonomyMassage Therapist
License NumberMA00014587
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: