MEDICARE: NAJWA JAFFAR AL BUSTANI M.D

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	204R00000X	Electrodiagnostic Medicine Physician	FE60361497	WA
2	390200000X	Student in an Organized Health Care Education/Training Program

General Provider Information

NPI Number	:	1992141162
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	NAJWA JAFFAR AL BUSTANI M.D

Provider Business Mailing Address
First Line	:	1959 NE PACIFIC ST BOX 356169
Second Line	:
City	:	SEATTLE
State	:	WA
Zip	:	98195-6169
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	1959 NE PACIFIC ST
Second Line	:	UNIVERSITY OF WA DEPT OF NEUROLOGY
City	:	SEATTLE
State	:	WA
Zip	:	98195-6465
Country	:	US
Telephone Number	:	206-616-5207
Fax Number	:

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

Provider Enumeration Date	:	05/15/2013
Last Update Date	:	03/25/2014

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