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General NPI Number Information
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NPI Number | 1295057230
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Entity Type | Organization
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Legal Business Name | NATURAL MOLECULAR TESTING CORPORATION
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Dates
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Enumeration Date | 02/18/2010
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Last Update Date | 02/17/2012
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Provider Practice Location Address
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Address Line | 223 SW 41ST ST UNIT#5
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City | RENTON
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State | WA
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Zip | 98057
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Country | US
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Telephone | 888-442-8881
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Fax |
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Provider Business Mailing Address
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Address Line | 223 SW 41ST ST UNIT#5
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City | RENTON
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State | WA
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Zip | 98057
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Country | US
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Telephone | 888-442-8881
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Fax |
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Authorized Official
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Title or Position | PRESIDENT & CEO
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Name | MR. BEAU REMBERT FESSENDEN
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Credential |
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Telephone | 253-630-9922
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 291U00000X
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Taxonomy Name | Clinical Medical Laboratory
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License Number | 50D1092274
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License Number State | WA
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