=====================================================
General NPI Number Information
=====================================================
NPI Number | 1679691166
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | LINDA LISE-MARIE DAGENAIS N.D.
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 03/26/2007
-----------------------------------------------------
Last Update Date | 06/22/2019
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 5600 KIRKWOOD PL N STE A
-----------------------------------------------------
City | SEATTLE
-----------------------------------------------------
State | WA
-----------------------------------------------------
Zip | 98103-5964
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 206-903-6111
-----------------------------------------------------
Fax | 206-903-6125
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 5600 KIRKWOOD PL N STE A
-----------------------------------------------------
City | SEATTLE
-----------------------------------------------------
State | WA
-----------------------------------------------------
Zip | 98103-5964
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 206-841-0588
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 175F00000X
-----------------------------------------------------
Taxonomy Name | Naturopath
-----------------------------------------------------
License Number | NT948
-----------------------------------------------------
License Number State | WA
-----------------------------------------------------