MEDICARE: BETH MARIE-JEAN FUGATE

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
2	101Y00000X	Counselor

General Provider Information

NPI Number	:	1700301454
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	BETH MARIE-JEAN FUGATE

Provider Business Mailing Address
First Line	:	851 POPLAR PL S
Second Line	:
City	:	SEATTLE
State	:	WA
Zip	:	98144-2827
Country	:	US
Telephone Number	:	206-324-9021
Fax Number	:

Provider Business Practice Location Address
First Line	:	851 POPLAR PL S
Second Line	:
City	:	SEATTLE
State	:	WA
Zip	:	98144-2827
Country	:	US
Telephone Number	:	800-991-5272
Fax Number	:	661-868-1839

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

Provider Enumeration Date	:	08/03/2017
Last Update Date	:	12/14/2021

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