Provider Demographics
NPI:1780219378
Name:EQUILIBRIYUM LLC
Entity Type:Organization
Organization Name:EQUILIBRIYUM LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PROVIDER
Authorized Official - Prefix:
Authorized Official - First Name:ELIZABETH
Authorized Official - Middle Name:
Authorized Official - Last Name:WYOSNICK
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:206-588-5261
Mailing Address - Street 1:3933 STONE WAY N
Mailing Address - Street 2:
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98103-8017
Mailing Address - Country:US
Mailing Address - Phone:206-588-5261
Mailing Address - Fax:
Practice Address - Street 1:3933 STONE WAY N
Practice Address - Street 2:
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98103-8017
Practice Address - Country:US
Practice Address - Phone:206-588-5261
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-03-04
Last Update Date:2020-03-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, RegisteredGroup - Single Specialty