Provider Demographics
NPI:1801495890
Name:TABAK, JULEAH R RUSSEK (ND)
Entity type:Individual
Prefix:
First Name:JULEAH
Middle Name:R RUSSEK
Last Name:TABAK
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 1:11521 SE 259TH ST UNIT 102
Mailing Address - Street 2:
Mailing Address - City:KENT
Mailing Address - State:WA
Mailing Address - Zip Code:98030-7856
Mailing Address - Country:US
Mailing Address - Phone:425-577-9414
Mailing Address - Fax:
Practice Address - Street 1:11521 SE 259TH ST # 102
Practice Address - Street 2:
Practice Address - City:KENT
Practice Address - State:WA
Practice Address - Zip Code:98030-7856
Practice Address - Country:US
Practice Address - Phone:425-577-9414
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-10-20
Last Update Date:2020-10-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WANT61092851175F00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes175F00000XOther Service ProvidersNaturopath