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General NPI Number Information
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NPI Number | 1932746468
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Entity Type | Organization
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Legal Business Name | BE FREE LIFESTYLE MEDICINE LLC
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Dates
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Enumeration Date | 12/03/2019
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Last Update Date | 01/28/2020
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Provider Practice Location Address
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Address Line | 110 CEDAR AVE APT 101
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City | SNOHOMISH
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State | WA
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Zip | 98290-2959
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Country | US
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Telephone | 360-282-4014
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Fax | 360-282-4017
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Provider Business Mailing Address
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Address Line | 2333 HARRISON AVE
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City | EVERETT
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State | WA
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Zip | 98201-3346
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Country | US
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Telephone | 425-344-8513
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Fax |
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Authorized Official
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Title or Position | MEMBER
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Name | THERESA LYNN FREE
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Credential | FNP
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Telephone | 425-344-8513
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QH0100X
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Taxonomy Name | Health Service Clinic/Center
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License Number |
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License Number State |
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