Provider Demographics
NPI:1659663888
Name:ISSAQUAH NATURAL MEDICINE, INC
Entity Type:Organization
Organization Name:ISSAQUAH NATURAL MEDICINE, INC
Other - Org Name:ISSAQUAH VALLEY NATURAL MEDICINE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:
Authorized Official - Last Name:NOWICKI
Authorized Official - Suffix:
Authorized Official - Credentials:ND
Authorized Official - Phone:425-391-7338
Mailing Address - Street 1:5825 221ST PL SE
Mailing Address - Street 2:SUITE 207
Mailing Address - City:ISSAQUAH
Mailing Address - State:WA
Mailing Address - Zip Code:98027-8927
Mailing Address - Country:US
Mailing Address - Phone:425-391-7338
Mailing Address - Fax:425-391-8330
Practice Address - Street 1:5825 221ST PL SE
Practice Address - Street 2:SUITE 207
Practice Address - City:ISSAQUAH
Practice Address - State:WA
Practice Address - Zip Code:98027-8927
Practice Address - Country:US
Practice Address - Phone:425-391-7338
Practice Address - Fax:425-391-8330
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-05-05
Last Update Date:2011-05-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WANT00001064175F00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes175F00000XOther Service ProvidersNaturopathGroup - Single Specialty