MEDICARE: DR. MARIAN SMALL ND MAC RN

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	610	WA

General Provider Information

NPI Number	:	1649314808
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. MARIAN SMALL ND MAC RN

Provider Business Mailing Address
First Line	:	1523 E MADISON ST
Second Line	:
City	:	SEATTLE
State	:	WA
Zip	:	98122-4013
Country	:	US
Telephone Number	:	206-322-4416
Fax Number	:	206-325-1218

Provider Business Practice Location Address
First Line	:	1523 E MADISON ST
Second Line	:
City	:	SEATTLE
State	:	WA
Zip	:	98122-4013
Country	:	US
Telephone Number	:	206-322-4416
Fax Number	:	206-325-1218

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

Provider Enumeration Date	:	02/19/2007
Last Update Date	:	07/08/2007

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