Provider Demographics
NPI:1437469442
Name:NOVOSELOVA, NATALIA P (LMP)
Entity Type:Individual
Prefix:
First Name:NATALIA
Middle Name:P
Last Name:NOVOSELOVA
Suffix:
Gender:F
Credentials:LMP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12908 NE 103RD PL
Mailing Address - Street 2:
Mailing Address - City:KIRKLAND
Mailing Address - State:WA
Mailing Address - Zip Code:98033-5278
Mailing Address - Country:US
Mailing Address - Phone:425-803-2051
Mailing Address - Fax:
Practice Address - Street 1:1632 116TH AVE NE
Practice Address - Street 2:
Practice Address - City:BELLEVUE
Practice Address - State:WA
Practice Address - Zip Code:98004-3035
Practice Address - Country:US
Practice Address - Phone:425-285-9304
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-10-12
Last Update Date:2010-10-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMA 60093871225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist