Healthcare Provider Details

I. General information

NPI: 1891416319
Provider Name (Legal Business Name): EBONY V GUTHRIE RPT CNA MAP CPT MROA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/05/2022
Last Update Date: 07/03/2026
Certification Date: 07/03/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4220 FACTORIA BLVD SE APT 209
BELLEVUE WA
98006-1910
US

IV. Provider business mailing address

4220 FACTORIA BLVD SE APT 210
BELLEVUE WA
98006-1910
US

V. Phone/Fax

Practice location:
  • Phone: 206-475-0965
  • Fax:
Mailing address:
  • Phone: 888-522-7443
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code246RM2200X
TaxonomyMedical Laboratory Technician
License NumberPC60569765
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: