Healthcare Provider Details

I. General information

NPI: 1912984717
Provider Name (Legal Business Name): CORAZON M LLAMAS RN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/22/2005
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1519 ALASKAN WAY SOUTH
SEATTLE WA
98131-4549
US

IV. Provider business mailing address

880 BREMERTON AVE NE
RENTON WA
98059-4549
US

V. Phone/Fax

Practice location:
  • Phone: 206-217-6432
  • Fax: 206-217-6636
Mailing address:
  • Phone: 425-255-4204
  • Fax: 425-255-4204

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number00109399
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: