Provider Demographics
NPI:1528395589
Name:BELLINGHAM NATURAL FAMILY MEDICINE
Entity Type:Organization
Organization Name:BELLINGHAM NATURAL FAMILY MEDICINE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BILLING MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:SHELLY
Authorized Official - Middle Name:D
Authorized Official - Last Name:DEROUSSEAU
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:360-752-9569
Mailing Address - Street 1:1810 BROADWAY
Mailing Address - Street 2:
Mailing Address - City:BELLINGHAM
Mailing Address - State:WA
Mailing Address - Zip Code:98225-3133
Mailing Address - Country:US
Mailing Address - Phone:360-738-7654
Mailing Address - Fax:360-738-8155
Practice Address - Street 1:1810 BROADWAY
Practice Address - Street 2:
Practice Address - City:BELLINGHAM
Practice Address - State:WA
Practice Address - Zip Code:98225-3133
Practice Address - Country:US
Practice Address - Phone:360-738-7654
Practice Address - Fax:360-738-8155
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-11-12
Last Update Date:2009-11-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WANT00001035207Q00000X
WANT00001641207Q00000X
WAAP60092299363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Multi-Specialty