MEDICARE: INTERGRATIVE MUSCULOSKELETAL MEDICINE AND WELLNESS

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	363L00000X	Nurse Practitioner	AP30007729	WA

General Provider Information

NPI Number	:	1518337336
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	INTERGRATIVE MUSCULOSKELETAL MEDICINE AND WELLNESS

Provider Business Mailing Address
First Line	:	7701 2ND AVE NE
Second Line	:
City	:	SEATTLE
State	:	WA
Zip	:	98115-4009
Country	:	US
Telephone Number	:	206-326-9198
Fax Number	:

Provider Business Practice Location Address
First Line	:	7701 2ND AVE NE
Second Line	:
City	:	SEATTLE
State	:	WA
Zip	:	98115-4009
Country	:	US
Telephone Number	:	206-326-9198
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	JOESEPH L WILMHOFF
Credential	:	ARNP, RN
Telephone Number	:	206-326-9198

Provider Enumeration Date	:	10/06/2015
Last Update Date	:	10/06/2015

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