=====================================================
General NPI Number Information
=====================================================
NPI Number | 1700048105
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | NESREEN LAHHAM MEDINA ND, LAC
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 06/26/2008
-----------------------------------------------------
Last Update Date | 08/16/2018
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 7214 LINDEN AVE N
-----------------------------------------------------
City | SEATTLE
-----------------------------------------------------
State | WA
-----------------------------------------------------
Zip | 98103
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 206-251-2491
-----------------------------------------------------
Fax | 844-704-9557
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 7214 LINDEN AVE N
-----------------------------------------------------
City | SEATTLE
-----------------------------------------------------
State | WA
-----------------------------------------------------
Zip | 98103-5112
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 206-251-2491
-----------------------------------------------------
Fax | 844-704-9557
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 175F00000X
-----------------------------------------------------
Taxonomy Name | Naturopath
-----------------------------------------------------
License Number | NT60014346
-----------------------------------------------------
License Number State | WA
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 171100000X
-----------------------------------------------------
Taxonomy Name | Acupuncturist
-----------------------------------------------------
License Number | AC00003069
-----------------------------------------------------
License Number State | WA
-----------------------------------------------------