Healthcare Provider Details

I. General information

NPI: 1700139706
Provider Name (Legal Business Name): MAXINE K ANDERSON M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/16/2012
Last Update Date: 10/16/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2100 WESTERN AVE #69
SEATTLE WA
98121
US

IV. Provider business mailing address

2030 WESTERN AVENUE #512
SEATTLE WA
98121
US

V. Phone/Fax

Practice location:
  • Phone: 206-956-4446
  • Fax:
Mailing address:
  • Phone: 206-498-9696
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code102L00000X
TaxonomyPsychoanalyst
License NumberMD00012206
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: