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General NPI Number Information
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NPI Number | 1417324997
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Entity Type | Individual
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Provider Name | MARY WHITEHEAD ND, LMP
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Gender | Female
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Dates
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Enumeration Date | 08/31/2015
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Last Update Date | 10/30/2017
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Provider Practice Location Address
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Address Line | 6830 NE BOTHELL WAY # C-105
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City | KENMORE
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State | WA
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Zip | 98028-3546
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Country | US
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Telephone | 704-577-1532
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Fax |
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Provider Business Mailing Address
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Address Line | 6830 NE BOTHELL WAY # C-105
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City | KENMORE
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State | WA
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Zip | 98028-3546
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Country | US
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Telephone | 704-577-1532
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 225700000X
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Taxonomy Name | Massage Therapist
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License Number | MA60236962
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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 | NT60796387
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License Number State | WA
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