MEDICARE: WENDY MARIE QUAST PCD

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	374J00000X	Doula

General Provider Information

NPI Number	:	1629696968
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	WENDY MARIE QUAST PCD

Provider Business Mailing Address
First Line	:	PO BOX 17399
Second Line	:
City	:	SEATTLE
State	:	WA
Zip	:	98127-1099
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	4229 1ST AVE NW
Second Line	:
City	:	SEATTLE
State	:	WA
Zip	:	98107-4303
Country	:	US
Telephone Number	:	206-375-0459
Fax Number	:

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

Provider Enumeration Date	:	07/13/2020
Last Update Date	:	07/13/2020

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