Healthcare Provider Details

I. General information

NPI: 1568289056
Provider Name (Legal Business Name): MARIAH KAYLEE OHLE RN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/25/2024
Last Update Date: 09/25/2024
Certification Date: 09/25/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5950 6TH AVE S STE 100
SEATTLE WA
98108-3317
US

IV. Provider business mailing address

5950 6TH AVE S STE 100
SEATTLE WA
98108-3317
US

V. Phone/Fax

Practice location:
  • Phone: 206-805-1930
  • Fax:
Mailing address:
  • Phone: 206-805-1930
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number61419539
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: