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General NPI Number Information
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NPI Number | 1710714365
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Entity Type | Organization
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Legal Business Name | FAUNTLEROY NATUROPATHIC MEDICINE
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Dates
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Enumeration Date | 09/17/2024
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Last Update Date | 09/17/2024
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Provider Practice Location Address
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Address Line | 12032 3RD AVE NE
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City | SEATTLE
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State | WA
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Zip | 98125-4728
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Country | US
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Telephone | 406-552-2927
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Fax | 800-776-2339
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Provider Business Mailing Address
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Address Line | 12032 3RD AVE NE
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City | SEATTLE
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State | WA
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Zip | 98125-4728
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Country | US
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Telephone | 406-552-2927
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Fax | 800-776-2339
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Authorized Official
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Title or Position | PHYSICIAN OWNER
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Name | JASON MICHAEL FAUNTLEROY
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Credential | ND
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Telephone | 406-552-2927
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 175F00000X
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Taxonomy Name | Naturopath
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License Number |
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License Number State |
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