Healthcare Provider Details

I. General information

NPI: 1467578393
Provider Name (Legal Business Name): OLYMPIC PLASTIC SURGERY SUITE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/22/2007
Last Update Date: 07/27/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2600 CHERRY AVENUE SUITE 201
BREMERTON WA
98310
US

IV. Provider business mailing address

2600 CHERRY AVENUE SUITE 201
BREMERTON WA
98310
US

V. Phone/Fax

Practice location:
  • Phone: 360-415-0762
  • Fax: 360-792-1166
Mailing address:
  • Phone: 360-415-0762
  • Fax: 360-792-1166

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QA1903X
TaxonomyAmbulatory Surgical Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: MRS. SUZANNE M FLETCHER
Title or Position: ADMINISTRATOR
Credential:
Phone: 360-415-0762