Provider Demographics
NPI:1902132160
Name:NEW LEAF NUTRITION, PLLC
Entity Type:Organization
Organization Name:NEW LEAF NUTRITION, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:DANIELLE
Authorized Official - Middle Name:
Authorized Official - Last Name:VENHUIZEN
Authorized Official - Suffix:
Authorized Official - Credentials:RD
Authorized Official - Phone:206-618-8245
Mailing Address - Street 1:3809 SW GRAHAM ST
Mailing Address - Street 2:
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98126-3035
Mailing Address - Country:US
Mailing Address - Phone:206-618-8245
Mailing Address - Fax:206-274-4810
Practice Address - Street 1:636 SW 152ND ST
Practice Address - Street 2:SUITE D
Practice Address - City:BURIEN
Practice Address - State:WA
Practice Address - Zip Code:98166-2264
Practice Address - Country:US
Practice Address - Phone:206-383-7704
Practice Address - Fax:206-274-4810
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-10-23
Last Update Date:2010-12-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WADI00002075261Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center