Provider Demographics
NPI:1205146818
Name:JEANNINE M WILMES LLC
Entity type:Organization
Organization Name:JEANNINE M WILMES LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JEANNINE
Authorized Official - Middle Name:
Authorized Official - Last Name:WILMES
Authorized Official - Suffix:
Authorized Official - Credentials:ND, LAC
Authorized Official - Phone:360-794-1456
Mailing Address - Street 1:PO BOX 252
Mailing Address - Street 2:
Mailing Address - City:MONROE
Mailing Address - State:WA
Mailing Address - Zip Code:98272-0252
Mailing Address - Country:US
Mailing Address - Phone:360-794-1456
Mailing Address - Fax:
Practice Address - Street 1:600 W MCGRAW ST STE 1
Practice Address - Street 2:
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98119-5801
Practice Address - Country:US
Practice Address - Phone:206-282-5386
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-10-15
Last Update Date:2010-10-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAAC60018053171100000X
WANT00001649175F00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes175F00000XOther Service ProvidersNaturopathGroup - Multi-Specialty
No171100000XOther Service ProvidersAcupuncturistGroup - Multi-Specialty