Provider Demographics
NPI:1164149480
Name:JAFFE, ATARA (ND)
Entity Type:Individual
Prefix:
First Name:ATARA
Middle Name:
Last Name:JAFFE
Suffix:
Gender:F
Credentials:ND
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2825 EASTLAKE AVE E STE 115
Mailing Address - Street 2:
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98102-3084
Mailing Address - Country:US
Mailing Address - Phone:206-420-1321
Mailing Address - Fax:833-584-0067
Practice Address - Street 1:2825 EASTLAKE AVE E STE 115
Practice Address - Street 2:
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98102-3084
Practice Address - Country:US
Practice Address - Phone:206-420-1321
Practice Address - Fax:833-584-0067
Is Sole Proprietor?:Yes
Enumeration Date:2022-10-26
Last Update Date:2022-10-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WANT61366665175F00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes175F00000XOther Service ProvidersNaturopathGroup - Single Specialty