Provider Demographics
NPI:1467964502
Name:GROUNDWORKS NUTRITION
Entity Type:Organization
Organization Name:GROUNDWORKS NUTRITION
Other - Org Name:GROUNDWORKS NUTRITION
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:ERIN
Authorized Official - Middle Name:ELIZABETH
Authorized Official - Last Name:SEKULICH
Authorized Official - Suffix:
Authorized Official - Credentials:MS, CN
Authorized Official - Phone:206-632-5662
Mailing Address - Street 1:105 NE 56TH ST
Mailing Address - Street 2:
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98105-3737
Mailing Address - Country:US
Mailing Address - Phone:206-632-5662
Mailing Address - Fax:
Practice Address - Street 1:2111 N NORTHGATE WAY STE 201
Practice Address - Street 2:
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98133
Practice Address - Country:US
Practice Address - Phone:206-525-8015
Practice Address - Fax:206-525-8014
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-10-30
Last Update Date:2018-07-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WANU00001465133N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes133N00000XDietary & Nutritional Service ProvidersNutritionistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
1548791957OtherNPI