Healthcare Provider Details

I. General information

NPI: 1477115863
Provider Name (Legal Business Name): NICOLE ANN HANBY
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/05/2019
Last Update Date: 07/05/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4325 UNIVERSITY WAY NE
SEATTLE WA
98105-5808
US

IV. Provider business mailing address

4325 UNIVERSITY WAY NE
SEATTLE WA
98105-5808
US

V. Phone/Fax

Practice location:
  • Phone: 206-633-5225
  • Fax: 206-633-1432
Mailing address:
  • Phone: 206-633-5225
  • Fax: 206-633-1432

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code156FX1800X
TaxonomyOptician
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: