Provider Demographics
NPI:1356654636
Name:BLUESTONE WELLNESS PLLC
Entity Type:Organization
Organization Name:BLUESTONE WELLNESS PLLC
Other - Org Name:BLUESTONE WELLNESS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:RACHEL
Authorized Official - Middle Name:ANTONINA
Authorized Official - Last Name:IACOBAZZI RIECAN
Authorized Official - Suffix:
Authorized Official - Credentials:LMP
Authorized Official - Phone:253-380-0434
Mailing Address - Street 1:9805 NE 116TH ST, PMB# 7238
Mailing Address - Street 2:
Mailing Address - City:KIRKLAND
Mailing Address - State:WA
Mailing Address - Zip Code:98034
Mailing Address - Country:US
Mailing Address - Phone:253-380-0434
Mailing Address - Fax:
Practice Address - Street 1:8514 49TH ST W
Practice Address - Street 2:
Practice Address - City:UNIVERSITY PLACE
Practice Address - State:WA
Practice Address - Zip Code:98467-1810
Practice Address - Country:US
Practice Address - Phone:253-380-0434
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-07-15
Last Update Date:2014-06-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QH0100XAmbulatory Health Care FacilitiesClinic/CenterHealth Service