Provider Demographics
NPI:1790882645
Name:RISLEY, REBECCA M (ND)
Entity Type:Individual
Prefix:DR
First Name:REBECCA
Middle Name:M
Last Name:RISLEY
Suffix:
Gender:F
Credentials:ND
Other - Prefix:DR
Other - First Name:MANDY
Other - Middle Name:
Other - Last Name:RISLEY
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:ND
Mailing Address - Street 1:1610 24TH AVE
Mailing Address - Street 2:
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98122-3011
Mailing Address - Country:US
Mailing Address - Phone:206-841-5537
Mailing Address - Fax:
Practice Address - Street 1:726 BROADWAY
Practice Address - Street 2:SUITE 301
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98122-4378
Practice Address - Country:US
Practice Address - Phone:206-726-0034
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WANT00001470175F00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes175F00000XOther Service ProvidersNaturopath