Organization
ILLUMINATE.ME LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
KELSEY FROULA ARNP (OWNER)
(360) 204-5202
Entity
Organization
Contact information
Practice address
3888 NW RANDALL WAY STE 203, SILVERDALE, WA 98383-7847
(360) 204-5202
Mailing address
3888 NW RANDALL WAY STE 203, SILVERDALE, WA 98383-7847
(136) 020-4520
Taxonomy
Speciality
Code
Description
License number
State
163W00000X
Registered Nurse
—
—
261QP2300X
Primary Care Clinic/Center
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
AP61110429
—
WA
Enumeration date
07/13/2021
Last updated
12/28/2021
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