Provider Demographics
NPI:1578119160
Name:AGISHEVA, JAMIE (ND)
Entity Type:Individual
Prefix:DR
First Name:JAMIE
Middle Name:
Last Name:AGISHEVA
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 1:14148 74TH PL NE APT D
Mailing Address - Street 2:
Mailing Address - City:KIRKLAND
Mailing Address - State:WA
Mailing Address - Zip Code:98034-4948
Mailing Address - Country:US
Mailing Address - Phone:818-425-1027
Mailing Address - Fax:
Practice Address - Street 1:18516 101ST AVE NE STE 3
Practice Address - Street 2:
Practice Address - City:BOTHELL
Practice Address - State:WA
Practice Address - Zip Code:98011-3874
Practice Address - Country:US
Practice Address - Phone:425-492-0082
Practice Address - Fax:425-250-8499
Is Sole Proprietor?:Yes
Enumeration Date:2019-08-10
Last Update Date:2023-06-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WANT609985482084N0008X, 174400000X, 175F00000X
261QI0500X, 261QM0850X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes175F00000XOther Service ProvidersNaturopath
No2084N0008XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeuromuscular Medicine
No261QI0500XAmbulatory Health Care FacilitiesClinic/CenterInfusion Therapy
No261QM0850XAmbulatory Health Care FacilitiesClinic/CenterAdult Mental Health
No174400000XOther Service ProvidersSpecialist