Healthcare Provider Details

I. General information

NPI: 1205983103
Provider Name (Legal Business Name): EMILY G. PEASE RN, IBCLC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/04/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1101 MADISON ST SUITE 800
SEATTLE WA
98104-1306
US

IV. Provider business mailing address

170 NW 73RD ST
SEATTLE WA
98117-4851
US

V. Phone/Fax

Practice location:
  • Phone: 206-386-3148
  • Fax: 206-215-2702
Mailing address:
  • Phone: 206-297-0106
  • Fax: 206-217-2702

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WL0100X
TaxonomyLactation Consultant (Registered Nurse)
License NumberRN00165180
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: