Provider Demographics
NPI:1598169062
Name:ROBERTSON, TACITA VANESSA (ND)
Entity Type:Individual
Prefix:DR
First Name:TACITA
Middle Name:VANESSA
Last Name:ROBERTSON
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 1:250 MARKET ST
Mailing Address - Street 2:
Mailing Address - City:KIRKLAND
Mailing Address - State:WA
Mailing Address - Zip Code:98033-6132
Mailing Address - Country:US
Mailing Address - Phone:206-334-7933
Mailing Address - Fax:
Practice Address - Street 1:250 MARKET ST
Practice Address - Street 2:
Practice Address - City:KIRKLAND
Practice Address - State:WA
Practice Address - Zip Code:98033-6132
Practice Address - Country:US
Practice Address - Phone:425-836-6650
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-10-13
Last Update Date:2014-10-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WANT60511046175F00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes175F00000XOther Service ProvidersNaturopath