Provider Demographics
NPI:1518337336
Name:INTERGRATIVE MUSCULOSKELETAL MEDICINE AND WELLNESS
Entity Type:Organization
Organization Name:INTERGRATIVE MUSCULOSKELETAL MEDICINE AND WELLNESS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JOESEPH
Authorized Official - Middle Name:L
Authorized Official - Last Name:WILMHOFF
Authorized Official - Suffix:
Authorized Official - Credentials:ARNP, RN
Authorized Official - Phone:206-326-9198
Mailing Address - Street 1:7701 2ND AVE NE
Mailing Address - Street 2:
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98115-4009
Mailing Address - Country:US
Mailing Address - Phone:206-326-9198
Mailing Address - Fax:
Practice Address - Street 1:7701 2ND AVE NE
Practice Address - Street 2:
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98115-4009
Practice Address - Country:US
Practice Address - Phone:206-326-9198
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-10-06
Last Update Date:2015-10-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAAP30007729363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGroup - Single Specialty