Provider Demographics
NPI:1881860799
Name:WELLS, AMY SUZANNE (ND, LMT)
Entity Type:Individual
Prefix:DR
First Name:AMY
Middle Name:SUZANNE
Last Name:WELLS
Suffix:
Gender:F
Credentials:ND, LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:105 NE 56TH ST
Mailing Address - Street 2:
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98105-3737
Mailing Address - Country:US
Mailing Address - Phone:206-257-5817
Mailing Address - Fax:206-257-5819
Practice Address - Street 1:105 NE 56TH ST
Practice Address - Street 2:
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98105-3737
Practice Address - Country:US
Practice Address - Phone:206-257-5817
Practice Address - Fax:206-257-5819
Is Sole Proprietor?:No
Enumeration Date:2008-05-01
Last Update Date:2013-11-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMA00009672225700000X
WANT60059892175F00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes175F00000XOther Service ProvidersNaturopath
No225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA0110798OtherLABOR AND INDUSTRIES