Provider Demographics
NPI:1093965154
Name:ROBERTS, CHENELLE A (ND, LM)
Entity type:Individual
Prefix:DR
First Name:CHENELLE
Middle Name:A
Last Name:ROBERTS
Suffix:
Gender:F
Credentials:ND, LM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5343 TALLMAN AVE NW STE 100
Mailing Address - Street 2:
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98107-3940
Mailing Address - Country:US
Mailing Address - Phone:206-706-0306
Mailing Address - Fax:206-706-4772
Practice Address - Street 1:5343 TALLMAN AVE NW STE 100
Practice Address - Street 2:
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98107-3940
Practice Address - Country:US
Practice Address - Phone:206-706-0306
Practice Address - Fax:206-706-4772
Is Sole Proprietor?:Yes
Enumeration Date:2008-09-25
Last Update Date:2008-09-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WANT00001436175F00000X
WAMW00000303176B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes175F00000XOther Service ProvidersNaturopath
No176B00000XOther Service ProvidersMidwife
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA7131816Medicaid