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General NPI Number Information
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NPI Number | 1104234533
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Entity Type | Organization
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Legal Business Name | ACTUAL WELLNESS LLC
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Dates
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Enumeration Date | 07/29/2014
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Last Update Date | 07/29/2014
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Provider Practice Location Address
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Address Line | 1512 NE 70TH ST
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City | SEATTLE
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State | WA
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Zip | 98115-5745
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Country | US
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Telephone | 360-320-6772
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Fax | 425-526-5659
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Provider Business Mailing Address
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Address Line | 1512 NE 70TH ST
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City | SEATTLE
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State | WA
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Zip | 98115-5745
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Country | US
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Telephone | 360-320-6772
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Fax | 425-526-5659
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Authorized Official
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Title or Position | CERTIFIED NUTRITIONIST/OWNER
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Name | HANNAH EPSTEIN
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Credential | MS
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Telephone | 360-320-6772
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 133N00000X
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Taxonomy Name | Nutritionist
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License Number | NUTR.NU.60316605
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License Number State | WA
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