Provider Demographics
NPI:1750924031
Name:IMPACT HEALTH NATUROPATHIC CLINIC, PLLC
Entity type:Organization
Organization Name:IMPACT HEALTH NATUROPATHIC CLINIC, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:LIUBOV
Authorized Official - Middle Name:
Authorized Official - Last Name:EVMESHKINA
Authorized Official - Suffix:
Authorized Official - Credentials:ND
Authorized Official - Phone:206-465-4415
Mailing Address - Street 1:17424 14TH DR SE
Mailing Address - Street 2:
Mailing Address - City:BOTHELL
Mailing Address - State:WA
Mailing Address - Zip Code:98012-6499
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:11419 19TH AVE SE STE A108
Practice Address - Street 2:
Practice Address - City:EVERETT
Practice Address - State:WA
Practice Address - Zip Code:98208-5120
Practice Address - Country:US
Practice Address - Phone:206-465-4415
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-10-19
Last Update Date:2019-10-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes175F00000XOther Service ProvidersNaturopathGroup - Single Specialty