Provider Demographics
NPI:1649369570
Name:KNICKREHM, WHITNEY ELIZA (ND)
Entity type:Individual
Prefix:
First Name:WHITNEY
Middle Name:ELIZA
Last Name:KNICKREHM
Suffix:
Gender:F
Credentials:ND
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1810 BROADWAY
Mailing Address - Street 2:
Mailing Address - City:BELLINGHAM
Mailing Address - State:WA
Mailing Address - Zip Code:98225-3133
Mailing Address - Country:US
Mailing Address - Phone:360-738-7654
Mailing Address - Fax:360-738-8155
Practice Address - Street 1:1810 BROADWAY
Practice Address - Street 2:
Practice Address - City:BELLINGHAM
Practice Address - State:WA
Practice Address - Zip Code:98225-3133
Practice Address - Country:US
Practice Address - Phone:360-738-7654
Practice Address - Fax:360-738-8155
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-11
Last Update Date:2009-11-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WANT00001035175F00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes175F00000XOther Service ProvidersNaturopath