Provider Demographics
NPI:1568647295
Name:WITALIS, MIROSLAWA (ND)
Entity Type:Individual
Prefix:
First Name:MIROSLAWA
Middle Name:
Last Name:WITALIS
Suffix:
Gender:F
Credentials:ND
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10212 5TH AVE NE
Mailing Address - Street 2:SUITE 201
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98125-7452
Mailing Address - Country:US
Mailing Address - Phone:206-525-0599
Mailing Address - Fax:206-525-5923
Practice Address - Street 1:10212 5TH AVE NE
Practice Address - Street 2:SUITE 201
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98125-7452
Practice Address - Country:US
Practice Address - Phone:206-525-0599
Practice Address - Fax:206-525-5923
Is Sole Proprietor?:No
Enumeration Date:2007-12-31
Last Update Date:2007-12-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WANT00001591175F00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes175F00000XOther Service ProvidersNaturopath