Healthcare Provider Details

I. General information

NPI: 1417182379
Provider Name (Legal Business Name): ERIKA BROOKE LMP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/21/2009
Last Update Date: 02/26/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

611 4TH AVE STE 100
KIRKLAND WA
98033-6019
US

IV. Provider business mailing address

12445 110TH LN NE APT Q103
KIRKLAND WA
98034-9191
US

V. Phone/Fax

Practice location:
  • Phone: 425-919-4103
  • Fax:
Mailing address:
  • Phone: 425-919-4103
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code174400000X
TaxonomySpecialist
License NumberMA60081935
License Number StateWA
# 2
Primary TaxonomyY
Taxonomy Code225700000X
TaxonomyMassage Therapist
License NumberMA60081935
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: