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General NPI Number Information
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NPI Number | 1174061543
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Entity Type | Organization
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Legal Business Name | ANTARES WELLNESS PLLC
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Dates
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Enumeration Date | 02/06/2017
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Last Update Date | 02/06/2017
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Provider Practice Location Address
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Address Line | 9319 7TH AVE S
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City | SEATTLE
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State | WA
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Zip | 98108-4604
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Country | US
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Telephone | 206-715-5265
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Fax |
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Provider Business Mailing Address
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Address Line | 9319 7TH AVE S
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City | SEATTLE
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State | WA
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Zip | 98108-4604
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Country | US
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Telephone | 206-715-5265
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Fax |
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Authorized Official
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Title or Position | OWNER, PRACTIONER
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Name | AMBER LASHANNA WILLIAMS
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Credential | LMP
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Telephone | 206-715-5265
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QM1300X
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Taxonomy Name | Multi-Specialty Clinic/Center
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License Number | MA60655160
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License Number State | WA
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