Organization
FERN LIFE CENTER
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MRS. ELIZABETH TILLMAN FITZGERALD RD (NUTRITIONIST)
(425) 391-3376
Entity
Organization
Contact information
Practice address
410 NEWPORT WAY NW, SUITE B, ISSAQUAH, WA 98027-3116
(425) 391-3376
(425) 391-3378
Mailing address
410 NEWPORT WAY NW, SUITE B, ISSAQUAH, WA 98027-3116
(425) 391-3376
(425) 391-3378
Taxonomy
Speciality
Code
Description
License number
State
261QH0100X
Health Service Clinic/Center
Primary
020710DI00000858
WA
Other
Enumeration date
03/18/2015
Last updated
03/18/2015
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