Provider Demographics
NPI:1952661647
Name:WHITE LOTUS NATURAL MEDICINE
Entity Type:Organization
Organization Name:WHITE LOTUS NATURAL MEDICINE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JENNA
Authorized Official - Middle Name:
Authorized Official - Last Name:ZAMPIELLO
Authorized Official - Suffix:
Authorized Official - Credentials:ND, LAC
Authorized Official - Phone:970-275-4334
Mailing Address - Street 1:413 FAIRVIEW AVE N
Mailing Address - Street 2:
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98109-5316
Mailing Address - Country:US
Mailing Address - Phone:970-275-4334
Mailing Address - Fax:206-623-5562
Practice Address - Street 1:413 FAIRVIEW AVE N
Practice Address - Street 2:
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98109-5316
Practice Address - Country:US
Practice Address - Phone:970-275-4334
Practice Address - Fax:206-623-5562
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-05-29
Last Update Date:2012-05-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WANT60200162305R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes305R00000XManaged Care OrganizationsPreferred Provider Organization