Healthcare Provider Details

I. General information

NPI: 1962950790
Provider Name (Legal Business Name): MARSHA BURNWORTH
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/21/2016
Last Update Date: 09/29/2026
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5215 46TH AVE S
SEATTLE WA
98118-2313
US

IV. Provider business mailing address

27617 129TH CT SE
KENT WA
98030-8853
US

V. Phone/Fax

Practice location:
  • Phone: 206-252-6907
  • Fax: 206-743-3158
Mailing address:
  • Phone: 206-252-6907
  • Fax: 206-743-3158

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WS0200X
TaxonomySchool Registered Nurse
License NumberRN60485754
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: