Healthcare Provider Details

I. General information

NPI: 1831885722
Provider Name (Legal Business Name): RICHELLE MEJIA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/13/2023
Last Update Date: 12/06/2023
Certification Date: 12/06/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1116 SUMMIT AVE
SEATTLE WA
98101-2831
US

IV. Provider business mailing address

1127 132ND ST SW APT B
EVERETT WA
98204-7372
US

V. Phone/Fax

Practice location:
  • Phone: 206-726-4100
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code164W00000X
TaxonomyLicensed Practical Nurse
License NumberLP60848465
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: