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General NPI Number Information
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NPI Number | 1770885089
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Entity Type | Individual
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Provider Name | PETRA ELENA EICHELSDOERFER RPH, MS, ND
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Gender | Female
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Dates
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Enumeration Date | 11/19/2010
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Last Update Date | 09/12/2024
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Provider Practice Location Address
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Address Line | 707 S GRADY WAY STE 600
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City | RENTON
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State | WA
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Zip | 98057-3227
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Country | US
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Telephone | 952-251-5529
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Fax | 877-787-5190
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Provider Business Mailing Address
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Address Line | 707 S GRADY WAY STE 600
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City | RENTON
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State | WA
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Zip | 98057-3227
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Country | US
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Telephone | 952-251-5529
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Fax | 877-787-5190
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 133N00000X
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Taxonomy Name | Nutritionist
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License Number | NU00002095
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License Number State | WA
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Taxonomy #2
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Taxonomy Code | 175F00000X
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Taxonomy Name | Naturopath
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License Number | NT00001260
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License Number State | WA
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Taxonomy #3
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Taxonomy Code | 1835P0018X
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Taxonomy Name | Pharmacist Clinician (PhC)/ Clinical Pharmacy Specialist
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License Number | PH 00014598
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License Number State | WA
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