Provider Demographics
NPI:1174061543
Name:ANTARES WELLNESS PLLC
Entity type:Organization
Organization Name:ANTARES WELLNESS PLLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER, PRACTIONER
Authorized Official - Prefix:
Authorized Official - First Name:AMBER LASHANNA
Authorized Official - Middle Name:
Authorized Official - Last Name:WILLIAMS
Authorized Official - Suffix:
Authorized Official - Credentials:LMP
Authorized Official - Phone:206-715-5265
Mailing Address - Street 1:9319 7TH AVE S
Mailing Address - Street 2:
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98108-4604
Mailing Address - Country:US
Mailing Address - Phone:206-715-5265
Mailing Address - Fax:
Practice Address - Street 1:9319 7TH AVE S
Practice Address - Street 2:
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98108-4604
Practice Address - Country:US
Practice Address - Phone:206-715-5265
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-02-06
Last Update Date:2017-02-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMA60655160261QM1300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM1300XAmbulatory Health Care FacilitiesClinic/CenterMulti-Specialty