Healthcare Provider Details

I. General information

NPI: 1407124407
Provider Name (Legal Business Name): NATALYA VLASKIN PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/05/2011
Last Update Date: 09/28/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3900 FACTORIA BLVD SE STE A
BELLEVUE WA
98006-1234
US

IV. Provider business mailing address

PO BOX 24105
SEATTLE WA
98124-0105
US

V. Phone/Fax

Practice location:
  • Phone: 425-903-3141
  • Fax:
Mailing address:
  • Phone: 142-590-3314
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License NumberPA 60252186
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: