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General NPI Number Information
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NPI Number | 1962770396
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Entity Type | Organization
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Legal Business Name | INNATE HEALTH AWARENESS LLC
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Dates
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Enumeration Date | 12/13/2011
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Last Update Date | 12/13/2011
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Provider Practice Location Address
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Address Line | 420 5TH AVE S SUITE 103
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City | EDMONDS
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State | WA
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Zip | 98020-3464
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Country | US
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Telephone | 206-618-6099
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Fax |
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Provider Business Mailing Address
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Address Line | 420 5TH AVE S SUITE 103
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City | EDMONDS
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State | WA
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Zip | 98020-3464
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Country | US
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Telephone | 206-618-6099
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | NATALIE-PASCALE A BOISSEAU
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Credential | LAC EAMP, LMP
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Telephone | 206-618-6099
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 174400000X
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Taxonomy Name | Specialist
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License Number | MA00022731
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License Number State | WA
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Taxonomy #2
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Taxonomy Code | 171100000X
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Taxonomy Name | Acupuncturist
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License Number | AC60175366
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License Number State | WA
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