Provider Demographics
NPI:1770885089
Name:EICHELSDOERFER, PETRA ELENA (RPH, MS, ND)
Entity type:Individual
Prefix:DR
First Name:PETRA
Middle Name:ELENA
Last Name:EICHELSDOERFER
Suffix:
Gender:F
Credentials:RPH, MS, ND
Other - Prefix:
Other - First Name:HELEN
Other - Middle Name:IRENE
Other - Last Name:EICHELSDOERFER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RPH
Mailing Address - Street 1:707 S GRADY WAY STE 600
Mailing Address - Street 2:
Mailing Address - City:RENTON
Mailing Address - State:WA
Mailing Address - Zip Code:98057-3227
Mailing Address - Country:US
Mailing Address - Phone:952-251-5529
Mailing Address - Fax:877-787-5190
Practice Address - Street 1:707 S GRADY WAY STE 600
Practice Address - Street 2:
Practice Address - City:RENTON
Practice Address - State:WA
Practice Address - Zip Code:98057-3227
Practice Address - Country:US
Practice Address - Phone:952-251-5529
Practice Address - Fax:877-787-5190
Is Sole Proprietor?:No
Enumeration Date:2010-11-19
Last Update Date:2024-09-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WANU00002095133N00000X
WANT00001260175F00000X
WAPH 000145981835P0018X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1835P0018XPharmacy Service ProvidersPharmacistPharmacist Clinician (PhC)/ Clinical Pharmacy Specialist
No133N00000XDietary & Nutritional Service ProvidersNutritionist
No175F00000XOther Service ProvidersNaturopath