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General NPI Number Information
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NPI Number | 1568110187
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Entity Type | Organization
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Legal Business Name | ROOTED HEART NUTRITION LLC
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Dates
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Enumeration Date | 03/14/2022
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Last Update Date | 03/14/2022
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Provider Practice Location Address
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Address Line | 4206 223RD PL SW
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City | MOUNTLAKE TERRACE
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State | WA
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Zip | 98043-3641
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Country | US
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Telephone | 303-478-9867
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Fax |
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Provider Business Mailing Address
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Address Line | 3011 196TH ST SW # 1037
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City | LYNNWOOD
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State | WA
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Zip | 98036-6925
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | CO-OWNER
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Name | EMILY HAYMOND
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Credential | MS, RDN
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Telephone | 303-478-9867
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QH0100X
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Taxonomy Name | Health Service Clinic/Center
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License Number |
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License Number State |
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