Provider Demographics
NPI:1356592240
Name:FRESONKE ND, INC
Entity type:Organization
Organization Name:FRESONKE ND, INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:JILL
Authorized Official - Middle Name:K
Authorized Official - Last Name:FRESONKE
Authorized Official - Suffix:
Authorized Official - Credentials:ND
Authorized Official - Phone:206-780-2626
Mailing Address - Street 1:147 MADRONE LN N
Mailing Address - Street 2:
Mailing Address - City:BAINBRIDGE ISLAND
Mailing Address - State:WA
Mailing Address - Zip Code:98110-1862
Mailing Address - Country:US
Mailing Address - Phone:206-780-2626
Mailing Address - Fax:206-780-0964
Practice Address - Street 1:147 MADRONE LN N
Practice Address - Street 2:
Practice Address - City:BAINBRIDGE ISLAND
Practice Address - State:WA
Practice Address - Zip Code:98110-1862
Practice Address - Country:US
Practice Address - Phone:206-780-2626
Practice Address - Fax:206-780-0964
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-10-09
Last Update Date:2008-10-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WANT00000818175F00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes175F00000XOther Service ProvidersNaturopathGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA1962545079OtherINDIVIDUAL NPI