Healthcare Provider Details

I. General information

NPI: 1922474790
Provider Name (Legal Business Name): BROOKE CELOVSKY
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/17/2015
Last Update Date: 08/17/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

401 BROADWAY
SEATTLE WA
98122
US

IV. Provider business mailing address

401 BROADWAY
SEATTLE WA
98122
US

V. Phone/Fax

Practice location:
  • Phone: 206-744-1600
  • Fax:
Mailing address:
  • Phone: 206-744-1600
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WE0003X
TaxonomyEmergency Registered Nurse
License NumberRN00169862
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: