Healthcare Provider Details

I. General information

NPI: 1740446772
Provider Name (Legal Business Name): INTEGRATIONWORKS LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/29/2008
Last Update Date: 10/08/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2025 112TH AVE NE SUITE 300
BELLEVUE WA
98004-2943
US

IV. Provider business mailing address

2025 112TH AVE NE SUITE 300
BELLEVUE WA
98004-2943
US

V. Phone/Fax

Practice location:
  • Phone: 206-328-5143
  • Fax: 425-452-5683
Mailing address:
  • Phone: 206-328-5143
  • Fax: 425-452-5683

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171W00000X
TaxonomyContractor
License Number602812545
License Number StateWA

VIII. Authorized Official

Name: MS. KAREN A PETERSEN
Title or Position: MANAGER
Credential: CHP, LMP
Phone: 206-328-5143