Healthcare Provider Details

I. General information

NPI: 1073149076
Provider Name (Legal Business Name): MICHELLE WARNER RN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/21/2020
Last Update Date: 03/21/2020
Certification Date: 03/21/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

325 9TH AVE
SEATTLE WA
98104-2420
US

IV. Provider business mailing address

2446 PARAMOUNT DR
ENUMCLAW WA
98022-2016
US

V. Phone/Fax

Practice location:
  • Phone: 206-744-3000
  • Fax:
Mailing address:
  • Phone: 360-367-2321
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WC0200X
TaxonomyCritical Care Medicine Registered Nurse
License NumberRN60406176
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: