Provider Demographics
NPI:1871091462
Name:MELISSA LARSON ND LLC
Entity type:Organization
Organization Name:MELISSA LARSON ND LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MS
Authorized Official - First Name:MELISSA
Authorized Official - Middle Name:MARIA
Authorized Official - Last Name:LARSON
Authorized Official - Suffix:
Authorized Official - Credentials:ND
Authorized Official - Phone:206-632-2154
Mailing Address - Street 1:5470 SHILSHOLE AVE NW
Mailing Address - Street 2:#300
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98107
Mailing Address - Country:US
Mailing Address - Phone:206-632-2154
Mailing Address - Fax:206-432-9509
Practice Address - Street 1:5470 SHILSHOLE AVE NW
Practice Address - Street 2:#300
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98107
Practice Address - Country:US
Practice Address - Phone:206-632-2154
Practice Address - Fax:206-432-9509
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-01-29
Last Update Date:2018-01-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WANT1362175F00000X
WA00001317175F00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes175F00000XOther Service ProvidersNaturopathGroup - Multi-Specialty