Provider Demographics
NPI:1881680627
Name:FAHOUM, MONAWAR T (ND)
Entity Type:Individual
Prefix:MS
First Name:MONAWAR
Middle Name:T
Last Name:FAHOUM
Suffix:
Gender:F
Credentials:ND
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5312 ROOSEVELT WAY NE
Mailing Address - Street 2:
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98105-3629
Mailing Address - Country:US
Mailing Address - Phone:206-525-8015
Mailing Address - Fax:206-525-8014
Practice Address - Street 1:5312 ROOSEVELT WAY NE
Practice Address - Street 2:
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98105-3629
Practice Address - Country:US
Practice Address - Phone:206-525-8015
Practice Address - Fax:206-525-8014
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-09-27
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WANT00001300175F00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes175F00000XOther Service ProvidersNaturopath