Healthcare Provider Details

I. General information

NPI: 1427964568
Provider Name (Legal Business Name):
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/19/2026
Last Update Date: 10/06/2026
Certification Date: 10/06/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

19125 N CREEK PKWY STE 125
BOTHELL WA
98011-8008
US

IV. Provider business mailing address

19125 N CREEK PKWY STE 125
BOTHELL WA
98011-8008
US

V. Phone/Fax

Practice location:
  • Phone: 425-537-3856
  • Fax: 425-249-3329
Mailing address:
  • Phone: 425-537-3856
  • Fax: 425-249-3329

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number
License Number StateNULL

VIII. Authorized Official

Name: CHENIN TOFFLEMIRE
Title or Position: NURSE PRACTITIONER
Credential: PMHNP
Phone: 425-537-3856