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1770885089 NPI number — PETRA ELENA EICHELSDOERFER RPH, MS, ND

NPI Number: 1770885089
Health Care Provider/Practitioner: PETRA ELENA EICHELSDOERFER RPH, MS, ND

Information about “1770885089” NPI (PETRA ELENA EICHELSDOERFER RPH, MS, ND) exists in 1770885089 in HTML format HTML  |  1770885089 in plain Text format TXT  |  1770885089 in PDF (Portable Document Format) PDF  |  1770885089 in an XML format XML  formats.

NPI Number : 1770885089 – JSON Data Format

                
{
  "Npi": {
    "NPI": "1770885089",
    "EntityType": "Individual",
    "ReplacementNPI": null,
    "EIN": null,
    "IsSoleProprietor": "N",
    "IsOrgSubpart": null,
    "ParentOrgLBN": null,
    "ParentOrgTIN": null,
    "OrgName": null,
    "LastName": "EICHELSDOERFER",
    "FirstName": "PETRA",
    "MiddleName": "ELENA",
    "NamePrefix": "DR.",
    "NameSuffix": null,
    "Credential": "RPH, MS, ND",
    "OtherOrgName": null,
    "OtherOrgNameTypeCode": null,
    "OtherLastName": "EICHELSDOERFER",
    "OtherFirstName": "HELEN",
    "OtherMiddleName": "IRENE",
    "OtherNamePrefix": null,
    "OtherNameSuffix": null,
    "OtherCredential": "RPH",
    "OtherLastNameTypeCode": "1",
    "FirstLineMailingAddress": "707 S GRADY WAY STE 600",
    "SecondLineMailingAddress": null,
    "MailingAddressCityName": "RENTON",
    "MailingAddressStateName": "WA",
    "MailingAddressPostalCode": "98057-3227",
    "MailingAddressCountryCode": "US",
    "MailingAddressTelephoneNumber": "952-251-5529",
    "MailingAddressFaxNumber": "877-787-5190",
    "FirstLinePracticeLocationAddress": "707 S GRADY WAY STE 600",
    "SecondLinePracticeLocationAddress": null,
    "PracticeLocationAddressCityName": "RENTON",
    "PracticeLocationAddressStateName": "WA",
    "PracticeLocationAddressPostalCode": "98057-3227",
    "PracticeLocationAddressCountryCode": "US",
    "PracticeLocationAddressTelephoneNumber": "952-251-5529",
    "PracticeLocationAddressFaxNumber": "877-787-5190",
    "EnumerationDate": "11/19/2010",
    "LastUpdateDate": "09/12/2024",
    "NPIDeactivationReasonCode": null,
    "NPIDeactivationReason": null,
    "NPIDeactivationDate": null,
    "NPIReactivationDate": null,
    "GenderCode": "F",
    "Gender": "Female",
    "AuthorizedOfficialLastName": null,
    "AuthorizedOfficialFirstName": null,
    "AuthorizedOfficialMiddleName": null,
    "AuthorizedOfficialTitle": null,
    "AuthorizedOfficialNamePrefix": null,
    "AuthorizedOfficialNameSuffix": null,
    "AuthorizedOfficialCredential": null,
    "AuthorizedOfficialTelephoneNumber": null,
    "Taxonomies": {
      "Taxonomy": [
        {
          "TaxonomyCode": "133N00000X",
          "TaxonomyName": "Nutritionist",
          "LicenseNumber": "NU00002095",
          "LicenseNumberStateCode": "WA",
          "PrimaryTaxonomySwitch": "N"
        },
        {
          "TaxonomyCode": "175F00000X",
          "TaxonomyName": "Naturopath",
          "LicenseNumber": "NT00001260",
          "LicenseNumberStateCode": "WA",
          "PrimaryTaxonomySwitch": "N"
        },
        {
          "TaxonomyCode": "1835P0018X",
          "TaxonomyName": "Pharmacist Clinician (PhC)/ Clinical Pharmacy Specialist",
          "LicenseNumber": "PH 00014598",
          "LicenseNumberStateCode": "WA",
          "PrimaryTaxonomySwitch": "Y"
        }
      ]
    },
    "HealthcareProviderTaxonomyGroups": null
  }
}
                
            

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