Provider Demographics
NPI:1669837746
Name:MOSAIC NATURAL FAMILY MEDICINE, PLLC
Entity Type:Organization
Organization Name:MOSAIC NATURAL FAMILY MEDICINE, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:KATHERINE
Authorized Official - Middle Name:VIRGINIA
Authorized Official - Last Name:SHORT
Authorized Official - Suffix:
Authorized Official - Credentials:ND
Authorized Official - Phone:206-363-5555
Mailing Address - Street 1:6300 9TH AVE NE
Mailing Address - Street 2:SUITE 300
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98115-8515
Mailing Address - Country:US
Mailing Address - Phone:206-363-5555
Mailing Address - Fax:206-363-5533
Practice Address - Street 1:6300 9TH AVE NE
Practice Address - Street 2:SUITE 300
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98115-8515
Practice Address - Country:US
Practice Address - Phone:206-363-5555
Practice Address - Fax:206-363-5533
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-12-16
Last Update Date:2015-12-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WANT 60425242175F00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes175F00000XOther Service ProvidersNaturopathGroup - Single Specialty