Provider Demographics
NPI:1285969345
Name:TAGGART, TRACI SQUIRES (ND)
Entity type:Individual
Prefix:DR
First Name:TRACI
Middle Name:SQUIRES
Last Name:TAGGART
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 1:10564 5TH AVE NE STE 406
Mailing Address - Street 2:
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98125-7200
Mailing Address - Country:US
Mailing Address - Phone:206-495-0018
Mailing Address - Fax:206-309-3336
Practice Address - Street 1:10564 5TH AVE NE STE 406
Practice Address - Street 2:
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98125-7200
Practice Address - Country:US
Practice Address - Phone:206-495-0018
Practice Address - Fax:206-309-3336
Is Sole Proprietor?:No
Enumeration Date:2009-10-07
Last Update Date:2023-04-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WANT60114221175F00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes175F00000XOther Service ProvidersNaturopath