Healthcare Provider Details

I. General information

NPI: 1881143758
Provider Name (Legal Business Name): ELIZABETH MACK RN, ARNP-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/03/2016
Last Update Date: 12/18/2025
Certification Date: 12/18/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3410 CLAREMONT AVE S
SEATTLE WA
98144-6815
US

IV. Provider business mailing address

PO BOX 18612
SEATTLE WA
98118-0612
US

V. Phone/Fax

Practice location:
  • Phone: 206-725-0747
  • Fax: 206-299-1814
Mailing address:
  • Phone: 206-725-0747
  • Fax: 206-299-1814

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License NumberRN60562783
License Number StateWA
# 2
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License NumberAP60691184
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: