Healthcare Provider Details

I. General information

NPI: 1689670192
Provider Name (Legal Business Name): MICHELLE OST MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/21/2005
Last Update Date: 03/07/2023
Certification Date: 09/29/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1033 REGENTS BLVD STE 102
FIRCREST WA
98466-6089
US

IV. Provider business mailing address

1033 REGENTS BLVD STE 102
FIRCREST WA
98466-6089
US

V. Phone/Fax

Practice location:
  • Phone: 253-564-1115
  • Fax: 253-565-4552
Mailing address:
  • Phone: 253-564-1115
  • Fax: 253-565-4552

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberMD00029726
License Number StateWA
# 2
Primary TaxonomyN
Taxonomy Code174400000X
TaxonomySpecialist
License NumberMD00029726
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: