Provider Demographics
NPI:1760050900
Name:STELLINA NATURAL MEDICINE
Entity Type:Organization
Organization Name:STELLINA NATURAL MEDICINE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:VIVIAN
Authorized Official - Middle Name:
Authorized Official - Last Name:SOVRAN
Authorized Official - Suffix:
Authorized Official - Credentials:ND
Authorized Official - Phone:206-321-1587
Mailing Address - Street 1:12911 120TH AVE NE STE E50
Mailing Address - Street 2:
Mailing Address - City:KIRKLAND
Mailing Address - State:WA
Mailing Address - Zip Code:98034-3046
Mailing Address - Country:US
Mailing Address - Phone:425-820-7700
Mailing Address - Fax:425-820-7707
Practice Address - Street 1:12911 120TH AVE NE STE E50
Practice Address - Street 2:
Practice Address - City:KIRKLAND
Practice Address - State:WA
Practice Address - Zip Code:98034-3046
Practice Address - Country:US
Practice Address - Phone:425-820-7700
Practice Address - Fax:425-820-7707
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-06-15
Last Update Date:2021-06-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care
No175F00000XOther Service ProvidersNaturopathGroup - Single Specialty