Healthcare Provider Details

I. General information

NPI: 1790552636
Provider Name (Legal Business Name): SEATTLE NAD PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/11/2023
Last Update Date: 12/26/2024
Certification Date: 12/26/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

15144 SE 46TH WAY
BELLEVUE WA
98006-3229
US

IV. Provider business mailing address

PO BOX 1775
MERCER ISLAND WA
98040-1775
US

V. Phone/Fax

Practice location:
  • Phone: 206-695-2707
  • Fax: 801-701-8387
Mailing address:
  • Phone: 952-417-6773
  • Fax: 801-701-8387

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2084A0401X
TaxonomyAddiction Medicine (Psychiatry & Neurology) Physician
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number
License Number State

VIII. Authorized Official

Name: DR. RICHARD EDUARDO REPASS
Title or Position: OWNER
Credential: MD
Phone: 952-417-6773