MEDICARE: CRISTINA MARIA PERSA MS, ND

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	175F00000X	Naturopath	NT60417517	WA

General Provider Information

NPI Number	:	1376974287
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CRISTINA MARIA PERSA MS, ND

Provider Business Mailing Address
First Line	:	6839 FORT DENT WAY STE 134
Second Line	:
City	:	TUKWILA
State	:	WA
Zip	:	98188-2597
Country	:	US
Telephone Number	:	206-812-9988
Fax Number	:	206-812-9989

Provider Business Practice Location Address
First Line	:	6839 FORT DENT WAY STE 134
Second Line	:
City	:	TUKWILA
State	:	WA
Zip	:	98188-2597
Country	:	US
Telephone Number	:	206-812-9988
Fax Number	:	206-812-9989

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	12/02/2013
Last Update Date	:	12/02/2013

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