NPIMap

Organization Active NPI

Fern Life Center

  • Health Service Clinic/Center
  • Issaquah, WA
National Provider Identifier
1245623024
Registry record updated Mar 18, 2015
On this page

Key facts

NPPES NPI Registry
Primary specialty
Health Service Clinic/CenterTaxonomy code 261QH0100X
License
020710DI00000858 Issued in WA
Legal business name
FERN LIFE CENTER
Practice address
410 Newport Way NW
Suite B
Issaquah, WA 98027-3116
Phone
(425) 391-3376
Fax
(425) 391-3378
NPI assigned
Mar 18, 2015
Last updated
Mar 18, 2015By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Mar 18, 2015

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Mrs. Elizabeth Tillman Fitzgerald, RDNPI 1942694666
Title
Nutritionist
Phone
(425) 391-3376

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Health Service Clinic/Center 261QH0100X 020710DI00000858 WA Primary

Addresses

Primary practice location

410 Newport Way NW
Suite B
Issaquah, WA 98027-3116

Mailing address

410 Newport Way NW
Suite B
Issaquah, WA 98027-3116
Phone (425) 391-3376

National Provider Directory

National Provider Directory
Tax ID family
Fern Life Center2 organizations share this tax ID, including this one

Other organizations with this tax ID 1

Organizations that report the same tax identification number in the National Provider Directory.

Locations

410 Newport Way NW
Ste B
Issaquah, WA 98027
Phone (425) 391-3376

Practitioners & affiliated clinicians

Practitioners 2

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1426636800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1426636800000",
    "number": "1245623024",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "410 NEWPORT WAY NW",
            "address_2": "SUITE B",
            "city": "ISSAQUAH",
            "state": "WA",
            "postal_code": "980273116",
            "telephone_number": "425-391-3376",
            "fax_number": "425-391-3378"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "410 NEWPORT WAY NW",
            "address_2": "SUITE B",
            "city": "ISSAQUAH",
            "state": "WA",
            "postal_code": "980273116",
            "telephone_number": "425-391-3376",
            "fax_number": "425-391-3378"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "FERN LIFE CENTER",
        "organizational_subpart": "NO",
        "enumeration_date": "2015-03-18",
        "last_updated": "2015-03-18",
        "status": "A",
        "authorized_official_last_name": "FITZGERALD",
        "authorized_official_first_name": "ELIZABETH",
        "authorized_official_middle_name": "TILLMAN",
        "authorized_official_title_or_position": "NUTRITIONIST",
        "authorized_official_telephone_number": "425-391-3376",
        "authorized_official_name_prefix": "Mrs.",
        "authorized_official_credential": "RD"
    },
    "taxonomies": [
        {
            "code": "261QH0100X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Health Service",
            "state": "WA",
            "license": "020710DI00000858",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Issaquah, WA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 18, 2015; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.