Healthcare Provider Details

I. General information

NPI: 1528924131
Provider Name (Legal Business Name): MAUREEN CORREIA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/27/2025
Last Update Date: 12/27/2025
Certification Date: 12/27/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

22125 17TH AVE SE
BOTHELL WA
98021-7406
US

IV. Provider business mailing address

22125 17TH AVE SE
BOTHELL WA
98021-7406
US

V. Phone/Fax

Practice location:
  • Phone: 509-655-0611
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WC0400X
TaxonomyCase Management Registered Nurse
License NumberRN60011107
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: