Provider Demographics
NPI:1942322615
Name:LARSON, MELISSA MARIA (ND)
Entity Type:Individual
Prefix:MS
First Name:MELISSA
Middle Name:MARIA
Last Name:LARSON
Suffix:
Gender:F
Credentials:ND
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:5470 SHILSHOLE AVE NW
Mailing Address - Street 2:SUITE # 300
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98107
Mailing Address - Country:US
Mailing Address - Phone:206-632-2154
Mailing Address - Fax:206-432-9509
Practice Address - Street 1:5470 SHILSHOLE AVE NW
Practice Address - Street 2:SUITE # 300
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98107
Practice Address - Country:US
Practice Address - Phone:206-632-2154
Practice Address - Fax:206-432-9509
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-04
Last Update Date:2018-12-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WANT00001362175F00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes175F00000XOther Service ProvidersNaturopath