Provider Demographics
NPI:1093477598
Name:VITAL ELEMENTS NATURAL MEDICINE LLC
Entity type:Organization
Organization Name:VITAL ELEMENTS NATURAL MEDICINE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CLINIC OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:BRITTNEY
Authorized Official - Middle Name:ANNA
Authorized Official - Last Name:NORTHROP
Authorized Official - Suffix:
Authorized Official - Credentials:ND
Authorized Official - Phone:360-818-9597
Mailing Address - Street 1:1720 MADISON ST
Mailing Address - Street 2:
Mailing Address - City:PORT TOWNSEND
Mailing Address - State:WA
Mailing Address - Zip Code:98368-4216
Mailing Address - Country:US
Mailing Address - Phone:860-933-1325
Mailing Address - Fax:
Practice Address - Street 1:219 A W PATISON ST
Practice Address - Street 2:
Practice Address - City:PORT HADLOCK
Practice Address - State:WA
Practice Address - Zip Code:98339-9833
Practice Address - Country:US
Practice Address - Phone:360-818-9597
Practice Address - Fax:360-845-8135
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-10-12
Last Update Date:2021-10-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes175F00000XOther Service ProvidersNaturopathGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA2159893Medicaid