MEDICARE: HEATHER MAHURIN

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	390200000X	Student in an Organized Health Care Education/Training Program

General Provider Information

NPI Number	:	1245970060
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	HEATHER MAHURIN

Provider Business Mailing Address
First Line	:	1959 NE PACIFIC ST, BB-1332
Second Line	:	BOX 356524
City	:	SEATTLE
State	:	WA
Zip	:	98195
Country	:	US
Telephone Number	:	206-685-6120
Fax Number	:

Provider Business Practice Location Address
First Line	:	1959 NE PACIFIC ST, BB-1332
Second Line	:
City	:	SEATTLE
State	:	WA
Zip	:	98195
Country	:	US
Telephone Number	:	206-685-6120
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	03/30/2022
Last Update Date	:	05/08/2023

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Directions to “ HEATHER MAHURIN ” Practice Location

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