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General NPI Number Information
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NPI Number | 1073092987
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Entity Type | Organization
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Legal Business Name | MADRONA NATURAL MEDICINE, LLC
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Dates
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Enumeration Date | 08/10/2018
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Last Update Date | 09/07/2018
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Provider Practice Location Address
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Address Line | 19201 108TH AVE SE STE 101
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City | RENTON
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State | WA
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Zip | 98055
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Country | US
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Telephone | 253-277-9130
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Fax | 253-981-3246
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Provider Business Mailing Address
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Address Line | 17653 134TH LN SE
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City | RENTON
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State | WA
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Zip | 98058-6817
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Country | US
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Telephone | 210-563-2111
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | JESSICA DOIZE
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Credential | ND
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Telephone | 253-277-9130
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 171100000X
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Taxonomy Name | Acupuncturist
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License Number |
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License Number State | WA
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Taxonomy #2
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Taxonomy Code | 175F00000X
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Taxonomy Name | Naturopath
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License Number |
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License Number State |
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