Healthcare Provider Details

I. General information

NPI: 1235208216
Provider Name (Legal Business Name): STACY MARIE BOWKER N.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: STACY MARIE THORNDIKE N.D.

II. Dates (important events)

Enumeration Date: 11/06/2006
Last Update Date: 12/14/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

110 CEDAR AVE SUITE 101
SNOHOMISH WA
98290-2900
US

IV. Provider business mailing address

110 CEDAR AVE SUITE 101
SNOHOMISH WA
98290-2900
US

V. Phone/Fax

Practice location:
  • Phone: 360-282-4014
  • Fax: 360-282-4017
Mailing address:
  • Phone: 360-282-4014
  • Fax: 360-282-4017

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code175F00000X
TaxonomyNaturopath
License NumberNT00001309
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: