Provider Demographics
NPI:1619185725
Name:BLAIR, TENNILLE KELSEY (ND)
Entity type:Individual
Prefix:DR
First Name:TENNILLE
Middle Name:KELSEY
Last Name:BLAIR
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 1:12422 107TH PL NE
Mailing Address - Street 2:
Mailing Address - City:KIRKLAND
Mailing Address - State:WA
Mailing Address - Zip Code:98034-8800
Mailing Address - Country:US
Mailing Address - Phone:206-669-0353
Mailing Address - Fax:
Practice Address - Street 1:12422 107TH PL NE
Practice Address - Street 2:
Practice Address - City:KIRKLAND
Practice Address - State:WA
Practice Address - Zip Code:98034-8800
Practice Address - Country:US
Practice Address - Phone:206-669-0353
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-21
Last Update Date:2024-11-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WANT00001419175F00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes175F00000XOther Service ProvidersNaturopath