Provider Demographics
NPI:1235519349
Name:NEUREVOLUTION MEDICINE, LLC
Entity Type:Organization
Organization Name:NEUREVOLUTION MEDICINE, LLC
Other - Org Name:DR. KAREN PARKER, ND, LLC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:REGISTERED AGENT
Authorized Official - Prefix:DR
Authorized Official - First Name:RICHARD
Authorized Official - Middle Name:DAVIS
Authorized Official - Last Name:BATSON
Authorized Official - Suffix:
Authorized Official - Credentials:ND
Authorized Official - Phone:425-780-6638
Mailing Address - Street 1:1300 114TH AVE SE
Mailing Address - Street 2:SUITE 106
Mailing Address - City:BELLEVUE
Mailing Address - State:WA
Mailing Address - Zip Code:98004-6942
Mailing Address - Country:US
Mailing Address - Phone:425-780-6638
Mailing Address - Fax:844-854-4660
Practice Address - Street 1:1300 114TH AVE SE
Practice Address - Street 2:SUITE 106
Practice Address - City:BELLEVUE
Practice Address - State:WA
Practice Address - Zip Code:98004-6942
Practice Address - Country:US
Practice Address - Phone:425-780-6638
Practice Address - Fax:844-854-4660
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-06-03
Last Update Date:2017-02-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WANT60555957175F00000X
WANT60555967175F00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes175F00000XOther Service ProvidersNaturopathGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WANATU.NT.60555967OtherWASHINGTON STATE DEPARTMENT OF HEALTH, NATUROPATHY