=====================================================
General NPI Number Information
=====================================================
NPI Number | 1376964247
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | VASHON NATURAL MEDICINE
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 12/19/2013
-----------------------------------------------------
Last Update Date | 12/19/2013
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 18913 VASHON HWY SW
-----------------------------------------------------
City | VASHON
-----------------------------------------------------
State | WA
-----------------------------------------------------
Zip | 98070-5215
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 206-463-4778
-----------------------------------------------------
Fax | 206-463-4791
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 18913 VASHON HWY SW
-----------------------------------------------------
City | VASHON
-----------------------------------------------------
State | WA
-----------------------------------------------------
Zip | 98070-5215
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 206-463-4778
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER, PHYSICIAN
-----------------------------------------------------
Name | DR. KELLY WRIGHT
-----------------------------------------------------
Credential | ND
-----------------------------------------------------
Telephone | 206-463-4778
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 208D00000X
-----------------------------------------------------
Taxonomy Name | General Practice Physician
-----------------------------------------------------
License Number | NT0000874
-----------------------------------------------------
License Number State | WI
-----------------------------------------------------