Healthcare Provider Details

I. General information

NPI: 1871548214
Provider Name (Legal Business Name): REICHEL DERMATOLOGY ASSOCIATES, PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/24/2006
Last Update Date: 01/20/2021
Certification Date: 01/20/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11011 MERIDIAN AVE N SUITE 102
SEATTLE WA
98133-8967
US

IV. Provider business mailing address

11011 MERIDIAN AVE N SUITE 102
SEATTLE WA
98133-8967
US

V. Phone/Fax

Practice location:
  • Phone: 206-859-5777
  • Fax: 206-859-5776
Mailing address:
  • Phone: 206-859-5777
  • Fax: 206-859-5776

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174400000X
TaxonomySpecialist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code207N00000X
TaxonomyDermatology Physician
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code207ND0101X
TaxonomyMOHS-Micrographic Surgery Physician
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code207ND0900X
TaxonomyDermatopathology Physician
License Number
License Number State
# 5
Primary TaxonomyN
Taxonomy Code207NI0002X
TaxonomyClinical & Laboratory Dermatological Immunology Physician
License Number
License Number State
# 6
Primary TaxonomyN
Taxonomy Code207NS0135X
TaxonomyProcedural Dermatology Physician
License Number
License Number State

VIII. Authorized Official

Name: DR. JENNIFER LYNN REICHEL
Title or Position: OWNER
Credential: MD
Phone: 206-859-5777