Provider Demographics
NPI:1538722947
Name:EVO NATUROPATHIC MEDICINE AND WELLNESS PLLC
Entity type:Organization
Organization Name:EVO NATUROPATHIC MEDICINE AND WELLNESS PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:SHANNON
Authorized Official - Middle Name:
Authorized Official - Last Name:ESTRADA
Authorized Official - Suffix:
Authorized Official - Credentials:ND
Authorized Official - Phone:206-486-0967
Mailing Address - Street 1:1231 SW 149TH ST
Mailing Address - Street 2:
Mailing Address - City:BURIEN
Mailing Address - State:WA
Mailing Address - Zip Code:98166-1750
Mailing Address - Country:US
Mailing Address - Phone:206-486-0967
Mailing Address - Fax:206-319-4514
Practice Address - Street 1:1231 SW 149TH ST
Practice Address - Street 2:
Practice Address - City:BURIEN
Practice Address - State:WA
Practice Address - Zip Code:98166-1750
Practice Address - Country:US
Practice Address - Phone:206-486-0967
Practice Address - Fax:206-319-4514
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-04-22
Last Update Date:2019-04-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes175F00000XOther Service ProvidersNaturopathGroup - Single Specialty