Healthcare Provider Details

I. General information

NPI: 1407078249
Provider Name (Legal Business Name): ANGELA-MARIE SLOTTEN LAC, CN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/02/2007
Last Update Date: 04/14/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

222 W MISSION AVE STE 248
SPOKANE WA
99201-2345
US

IV. Provider business mailing address

222 W MISSION AVE STE 248
SPOKANE WA
99201-2345
US

V. Phone/Fax

Practice location:
  • Phone: 509-326-6654
  • Fax:
Mailing address:
  • Phone: 509-326-6654
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code133N00000X
TaxonomyNutritionist
License NumberNU00001501
License Number StateWA
# 2
Primary TaxonomyY
Taxonomy Code171100000X
TaxonomyAcupuncturist
License Number2032
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: