Healthcare Provider Details

I. General information

NPI: 1568142289
Provider Name (Legal Business Name): IAM CENTER FOR INTEGRATIVE AESTHETIC MEDICINE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/18/2023
Last Update Date: 07/18/2023
Certification Date: 07/18/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1550 140TH AVE NE STE 200
BELLEVUE WA
98005-4500
US

IV. Provider business mailing address

1550 140TH AVE NE STE 200
BELLEVUE WA
98005-4500
US

V. Phone/Fax

Practice location:
  • Phone: 425-502-7916
  • Fax:
Mailing address:
  • Phone: 425-502-7916
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LW0102X
TaxonomyWomen's Health Nurse Practitioner
License Number
License Number State

VIII. Authorized Official

Name: MRS. AMI MICHELLE BROWN
Title or Position: CEO
Credential: WHNP-BC
Phone: 425-502-7916