Healthcare Provider Details

I. General information

NPI: 1932746468
Provider Name (Legal Business Name): BE FREE LIFESTYLE MEDICINE LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/03/2019
Last Update Date: 01/28/2020
Certification Date: 01/28/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

110 CEDAR AVE APT 101
SNOHOMISH WA
98290-2959
US

IV. Provider business mailing address

2333 HARRISON AVE
EVERETT WA
98201-3346
US

V. Phone/Fax

Practice location:
  • Phone: 360-282-4014
  • Fax: 360-282-4017
Mailing address:
  • Phone: 425-344-8513
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QH0100X
TaxonomyHealth Service Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: THERESA LYNN FREE
Title or Position: MEMBER
Credential: FNP
Phone: 425-344-8513