| |
747 Broadway Seattle WA 98122-4379 | |
(206) 215-2520 | |
(206) 986-3180 |
Full Name | |
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Speciality | Nurse Practitioner - Adult Health |
Location | 747 Broadway, Seattle, Washington |
Authorized Official Name and Position | Kevin L Brown (VICE PRESIDENT) |
Authorized Official Contact | 2063203665 |
Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
Mailing Address | Practice Location Address |
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Po Box 84026 Seattle WA 98124-8426 Ph: (206) 320-4933 | 747 Broadway Seattle WA 98122-4379 Ph: (206) 215-2520 |
NPI Number | 1053362327 |
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Provider Enumeration Date | 05/12/2006 |
Last Update Date | 08/22/2020 |
Identifier | Type | State | Issuer |
---|---|---|---|
1053362327 | NPI | - | NPPES |
7105190 | Medicaid | WA |
Taxonomy | Type | License (State) | Status |
---|---|---|---|
207R00000X | Internal Medicine | (Washington) | Primary |
363A00000X | Physician Assistant | (Washington) | Primary |
363LA2200X | Nurse Practitioner - Adult Health | (Washington) | Primary |
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